Cost-effectiveness modeling of early lead extraction for cardiac implantable electronic device infections in the United Kingdom
A Rinaldi, S Howell, S Verma, J H Youn, A Uehlin, H Vanden BaviereAbstract
Background
The global adoption of cardiac implantable electronic devices (CIEDs) has expanded significantly in recent decades, supported by broadening clinical indications and their demonstrated efficacy in managing a spectrum of cardiac disorders. Subsequently, over one million CIEDs are implanted annually worldwide with a corresponding rise in CIED infections, contributing significantly to patient morbidity, mortality, and healthcare costs. Despite strong guideline recommendations for prompt and complete device removal, real-world adherence remains suboptimal, with delays in extraction being common.
Purpose
This study evaluates the cost-effectiveness of early lead extraction (≤7 days post-diagnosis) compared to delayed (>7 days) or no extraction for CIED infections in the United Kingdom, using a decision-analytic model from the UK National Health Service (NHS) perspective.
Methods
A decision-tree model was constructed to simulate clinical and economic outcomes in adult patients with systemic or pocket CIED infections. Model inputs were sourced from published literature and NHS cost data (2023 GBP). Outcomes were measured as adverse events avoided, and total costs over a 1-year time horizon. Sensitivity analyses (deterministic and probabilistic) assessed model robustness.
Results
Early extraction was both clinically and economically superior to delayed or no extraction. For systemic infections, early extraction reduced costs by £753,708 and avoided 25.2 adverse events per 100 patients, with mortality falling from 19.95 to 7.5 per 100 patients. In pocket infections, early extraction lowered costs by £104,904 and increased adverse event-free patients by 23.7 per 100, with mortality decreasing from 12.38 to 0.90 per 100 patients. Sensitivity analyses confirmed the robustness of these findings, with antibiotic failure rates being the most influential parameter.
Conclusions
Early lead extraction for CIED infections is a cost-effective, dominant strategy in the UK, reducing mortality, adverse events, and overall costs. These results strongly support guideline recommendations for prompt extraction and highlight the need for improved adherence to evidence-based management of CIED infections.Figure 1Figure 2