Cost-effectiveness of an antibacterial envelope for infection prevention in patients undergoing cardiac resynchronization therapy reoperations in Denmark

Maria Hee Jung Park Frausing*, Jens Brock Johansen, Daniela Afonso, Ole Dan Jørgensen, Thomas Olsen, Christian Gerdes, Mette Lundsby Johansen, Claudia Wolff, Stuart Mealing, Jens Cosedis Nielsen, Mads Brix Kronborg

*Corresponding author for this work

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Aims Use of an absorbable antibacterial envelope during implantation prevents cardiac implantable electronic device infections in patients with a moderate-to-high infection risk. Previous studies demonstrated that an envelope is cost-effective in high-risk patients within German, Italian, and English healthcare systems, but these analyses were based on limited data and may not be generalizable to other healthcare settings. Methods A previously published decision-tree-based cost-effectiveness model was used to compare the costs per quality-adjusted life and results year (QALY) associated with adjunctive use of an antibacterial envelope for infection prevention compared to standard-of-care intravenous antibiotics. The model was adapted using data from a Danish observational two-centre cohort study that investigated infection-risk patients undergoing cardiac resynchronization therapy (CRT) reoperations with and without an antibacterial envelope (n = 1943). We assumed a cost-effectiveness threshold of €34 125/QALY gained, based on the upper threshold used by the National Institute for Health and Care Excellence (£30 000). An antibacterial envelope was associated with an incremental cost-effectiveness ratio (ICER) of €12 022 per QALY in patients undergoing CRT reoperations, thus indicating that the envelope is cost-effective when compared with standard of care. A separate analysis stratified by device type showed ICERS of €6227 (CRT defibrillator) and €29 177 (CRT pacemaker) per QALY gained. Conclusions Cost-effectiveness ratios were favourable for patients undergoing CRT reoperations in the Danish healthcare system, and thus are in line with previous studies. Results from this study can contribute to making the technology available to Danish patients and align preventive efforts in the pacemaker and ICD area. (Figure Presented) CIED, cardiac implantable electronic device; CRT, cardiac resynchronization therapy (-P, pacemaker; -D, defibrillator); ICER, incremental cost-effectiveness ratio; HR, hazard ratio; IQR, interquartile range; QALY, quality-adjusted life year.

Original languageEnglish
Article number25
JournalEP - Europace
Issue number6
Number of pages9
Publication statusPublished - 1. Jun 2023


  • Antibacterial envelope
  • Cardiac resynchronization therapy
  • Cost-effectiveness analysis
  • Implantable cardioverter defibrillator
  • Infection
  • Pacemaker
  • Reoperation
  • Humans
  • Cardiac Resynchronization Therapy/adverse effects
  • Cost-Benefit Analysis
  • Denmark
  • Anti-Bacterial Agents/therapeutic use
  • Cohort Studies


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