Economic Evaluation of Fractional Flow Reserve–Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease

Abstract

Background-The Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study demonstrated significantly improved health outcomes at 1 year in patients randomized to multivessel percutaneous coronary intervention guided by fractional flow reserve (FFR) compared with percutaneous coronary intervention guided by angiography alone. The economic impact of routine measurement of FFR in this setting is not known. Methods and Results-In this study, 1005 patients were randomly assigned to FFR-guided or angiography-guided percutaneous coronary intervention and followed up for 1 year. A prospective cost-utility analysis comparing costs and quality-adjusted life-years was performed with a time horizon of 1 year. Quality-adjusted life-years were calculated with the use of utilities determined by the EuroQuol 5 dimension health survey with US weights. Direct medical costs included those of the index procedure and hospitalization and costs for major adverse cardiac events during follow-up. Confidence intervals for both quality-adjusted life-years and costs were estimated by the bootstrap percentile method. Major adverse cardiac events at 1 year occurred in 13.2% of those in the FFR-guided arm and 18.3% of those in the angiography-guided arm (Pϭ0.02). Quality-adjusted life-years were slightly greater in the FFR-guided arm (0.853 versus 0.838; Pϭ0.2). Mean overall costs at 1 year were significantly less in the FFR-guided arm ($14 315 versus $16 700; PϽ0.001). Bootstrap simulation indicated that the FFR-guided strategy was cost-saving in 90.74% and cost-effective at a threshold of US $50 000 per quality-adjusted life-years in 99.96%. Sensitivity analyses demonstrated robust results. Conclusion-Economic evaluation of the FAME study reveals that FFR-guided percutaneous coronary intervention in patients with multivessel coronary disease is one of those rare situations in which a new technology not only improves outcomes but also saves resources. Clinical Trial Registration-URL: http://ClinicalTrials.gov.

Fractional Flow Reserve for Intermediate Coronary Artery Stenosis in Nepal

“…An economic evaluation verified that FFR-guided PCI is a cost-saving strategy 13 , with fewer stents deployed and less contrast used. FIND study had showed that FFR is cost effective.…”

Anatomic or Functional Evaluation as an Initial Test for Stable Coronary Artery Disease: A Propensity Score Analysis

“…A recent study with an assessment of fractional flow reserves also showed that CAG is not always accurate for assessing the functional significance of a coronary stenosis, regardless of the angiographic severity (3). Unnecessary revascularization can lead to increased costs, radiation exposure, and procedural complications without clinical benefits (4,5). In our present study, the CAG group underwent more coronary revascularization.…”

“…However, substantial discrepancies between angiographic anatomic findings and functional severity of stenosis have been noted (2,3). Additionally, coronary revascularization without documentation of ischemia using functional tests might lead to increased medical costs and deterioration in clinical prognoses (4)(5)(6).…”

Almanac 2011: stable coronary artery disease. The national society journals present selected research that has driven recent advances in clinical cardiology

“…42 In the FFR group, the number of stents per patient (1.9±1.3 vs 2.7±1.2) and the primary end point of death, non-fatal myocardial infarction or target vessel revascularisation at 1 year (13.2% vs 18.3%) were both significantly lower than for the angiography group. Benefits were largely sustained at 2 years 43 and evidence of cost-effectiveness 44 completes the case in favour of FFR-guided PCI in multivessel procedures.…”