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

Figures & data

Figure 1. Decision analytic model developed to analyse the expected economic impact of introducing TYRX.

Table 1. Parameters of economic model.

Parameter	Value	Source
Infection cost	£61,585.76	GLM estimate
Mean cost of TYRX	£719.00	Reported market price
Probability of infection in the No TYRX group	3.205%	Retrospective data
Odds ratio of TYRX vs No TYRX	0.31	Koerber et al.
Probability of infection in the TRX group	1.0161%	Derived from Koerber et al. and retrospective data

Table 2. ICD and CRT device procedures in HFrEF patients between 1 January 2014 and 31 September 2017.

	ICD	CRT-P	CRT-D	Total
Generator change	4	11	29	44
Upgrade	—	16	10	26
New implant	28	19	42	89
Total	32	46	81	159

Abbreviations. CRT-D, Cardiac Resynchronization Therapy Defibrillator; CRT-P, Cardiac Resynchronization Therapy Pacemaker; ICD, Implantable Cardioverter Defibrillator.

Table 3. Baseline characteristics, comorbidities, and CIED risk factors in patients with and without CIED infections (n/%).

	Infection group (n = 5)	Non-infection group (n = 152)
Age (mean/range)	67 (54–82)	68 (22–92)
Gender: Male	4 (80%)	115 (76%)
Anaemia	1 (20%)	29 (19%)
Atrial Fibrillation	2 (40%)	79 (52%)
CAD	2 (40%)	79 (52%)
Malignancy	0 (0%)	22 (14%)
COPD	3 (60%)	47 (31%)
Dementia	0 (0%)	5 (3%)
Diabetes	2 (40%)	72 (47%)
Hypertension	4 (80%)	118 (78%)
Sleep Apnoea	0 (0%)	23 (15%)
CKD	2 (40%)	57 (38%)
Stroke	0 (0%)	5 (3%)
Valve Disease	4 (80%)	49 (32%)
Myocardial Infarction	3 (60%)	64 (42%)
Mood Disorder	0 (0%)	23 (15%)
Anticoagulation Therapy	2 (40%)	80 (53%)
Generator Change/Upgrade Procedure	2 (40%)	68 (45%)
Presence of Defibrillation Lead	5 (100%)	106 (70%)

Abbreviations. CAD, Coronary Artery Disease; CKD, Chronic Kidney Disease; COPD, Chronic Obstructive Pulmonary Disease.

Figure 2. Histogram of total costs after 12-month follow-up (n = 159).

Table 4. Sensitivity analysis on cost estimation method.

Method of cost estimation	Total cost (SE)	Infection cost (SE)	Expected savings (95% CI)
GLM	13,193.64 (979.57)	62,213.94 (16,967.81)	624.09 (597.00–651.16)
OLS + Bootstrap	13,385.04 (54.06)	58,841.7 (644)	514.23 (484.74–543.71)
Attribution of resource use	13,425.61* (1,716.69 )	41,820.4** (13,257.28)	184.67 (164.68–204.67)

* Average cohort total cost.

** Average cost of attribution of resource use in only infected patients.

Abbreviations. CI, Confidence Interval; GLM, Generalized Linear Model; OLS, Ordinary Least Squares; SE, standard error.