Academic Journal
Cost-effectiveness modelling of early lead extraction for cardiac implantable electronic device infections in the United Kingdom.
| Τίτλος: | Cost-effectiveness modelling of early lead extraction for cardiac implantable electronic device infections in the United Kingdom. |
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| Συγγραφείς: | Rinaldi A; Cardiology, St Thomas' Hospital, London, England, UK., Howell S; Department of Bioengineering and Imaging Sciences, King's College London, London, UK., Verma S; Chief Medical Office - Health Economics and Outcomes Research, Philips, Eindhoven, the Netherlands., Youn JH; Chief Medical Office - Health Economics and Outcomes Research, Philips, Eindhoven, the Netherlands., Uehlin A; Chief Medical Office - Medical Affairs, Philips, Cambridge, England, USA., Vanden Bavière H; Chief Medical Office - Health Economics and Outcomes Research, Philips, Eindhoven, the Netherlands henri.vandenbaviere@philips.com.; Department of Medicine, Erasmus University College, Anderlecht, Brussels, Belgium. |
| Πηγή: | BMJ open [BMJ Open] 2026 Apr 24; Vol. 16 (4), pp. e113198. Date of Electronic Publication: 2026 Apr 24. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [London] : BMJ Publishing Group Ltd, 2011- |
| Ιατρικοί όροι (MeSH): | Device Lead Extraction*/economics , Defibrillators, Implantable*/adverse effects , Prosthesis-Related Infections*/economics , Prosthesis-Related Infections*/surgery , Pacemaker, Artificial*/adverse effects , Cost-Benefit Analysis*, Humans ; United Kingdom ; Cost-Effectiveness Analysis ; Decision Trees ; Time Factors ; Health Care Costs |
| Περίληψη: | Objectives: To evaluate the cost-effectiveness of early lead extraction (≤7 days post-admission) compared with delayed (>7 days) or no extraction for cardiac implantable electronic device (CIED) infections in the UK using a decision-analytic model from the NHS perspective. Design: A decision-tree model was constructed to simulate clinical and economic outcomes in adult patients with systemic or pocket CIED infections. Setting: Secondary care hospital setting within the UK NHS. Participants: A simulated cohort of adult patients with systemic or pocket CIED infections. Model inputs were sourced from published literature and NHS cost data (2023 £). Interventions: Early lead extraction (≤7 days after diagnosis/admission) compared with delayed extraction (>7 days) or no extraction. Primary and Secondary Outcome Measures: Adverse events avoided and total healthcare costs over a 1-year time horizon; deterministic and probabilistic sensitivity analyses were conducted to assess model robustness. Results: Early extraction was both clinically and economically superior to delayed or no extraction. For systemic infections, early extraction reduced costs by £123 056 and avoided 9.0 adverse events per 100 patients, with mortality falling from 20.0 to 7.5 per 100 patients. In pocket infections, early extraction lowered costs by £104 904 and avoided 8.4 adverse events per 100 patients, with mortality decreasing from 12.4 to 0.9 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. (© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.) |
| Competing Interests: | Competing interests: CAR receives honorary/speaker fees from Philips. SH received fellowship funding from Philips, Abbott and EBR. SV, J-HY, AU and HVB are employees of Philips. |
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| Contributed Indexing: | Keywords: Adult cardiology; HEALTH ECONOMICS; Pacing & electrophysiology |
| Entry Date(s): | Date Created: 20260424 Date Completed: 20260715 Latest Revision: 20260813 |
| Update Code: | 20260919 |
| PubMed Central ID: | PMC13110586 |
| DOI: | 10.1136/bmjopen-2025-113198 |
| PMID: | 42031502 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 2044-6055 |
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| DOI: | 10.1136/bmjopen-2025-113198 |