Economic impact of introducing TYRX amongst patients with heart failure and reduced ejection fraction undergoing implanted cardiac device procedures: a retrospective model based cost analysis.

BACKGROUND AND AIMS: Infection is a serious and expensive complication of Cardiac Implantable Electronic Device (CIED) procedures. A retrospective based cost analysis was performed to estimate Trust level savings of using the TYRX antibacterial envelope as a primary prevention measure against infection in a tertiary referral centre in South London, UK. METHODS: A retrospective cohort of heart failure patients with reduced ejection fraction undergoing Implantable Cardioverter Defibrillator (ICD) or Cardiac Resynchronization Therapy (CRT) procedures were evaluated. Decision-analytic modelling was performed to determine economic savings of using the envelope during CIED procedure vs CIED procedure alone. RESULTS: Over a 12 month follow-up period following CIED procedure, the observed infection rate was 3.14% (n = 5/159). The average cost of a CIED infection inpatient admission was £41,820 and, further to economic analysis, the additional costs attributable to infection was calculated at £62,213.94. A cost saving of £624 per patient by using TYRX during CIED procedure as a primary preventative measure against infection was estimated. CONCLUSIONS: TYRX would be a cost-saving treatment option amongst heart failure patients undergoing ICD and CRT device procedures based on analysis in the local geographical area of South London. If upscaled to the UK population, we estimate potential cost savings for the National Health Service (NHS).

Cardiac resynchronisation therapy for heart failure.

Cardiac resynchronisation therapy (CRT) reduces symptoms and improves left ventricular function in chronic heart failure (CHF) patients with left ventricular systolic dysfunction and prolonged QRS duration. Recent studies have demonstrated a reduction in mortality associated with CRT. When combined with an implantable cardioverter defibrillator (ICD) reduction in mortality is likely to reduce further. Cardiac resynchronisation therapy is well tolerated and free from compliance issues and therefore should be considered for all suitable patients. Identifying patients who will derive maximum benefit requires further study and has health economic implications. We review here the CRT trial evidence as well as the implantation technique and complications. We also describe a case report where an intra-aortic balloon pump was used successfully as a bridge to CRT to treat a patient with end-stage heart failure.

The implantable cardioverter defibrillator.

The implantable cardioverter defibrillator is the optimal treatment for both primary and secondary prevention in patients with previous aborted sudden death and with life-threatening cardiac arrhythmias. This article will review the indications and the evidence supporting implantable cardioverter defibrillator use.