ArticleBMJ open2026
Cost-effectiveness modelling of early lead extraction for cardiac implantable electronic device infections in the United Kingdom.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
objectivesTo 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.
designA decision-tree model was constructed to simulate clinical and economic outcomes in adult patients with systemic or pocket CIED infections.
settingSecondary care hospital setting within the UK NHS.
participantsA simulated cohort of adult patients with systemic or pocket CIED infections. Model inputs were sourced from published literature and NHS cost data (2023 £).
interventionsEarly 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.
resultsEarly 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.
conclusionsEarly 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.
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