Abstract
Percutaneous coronary intervention (PCI) based on fractional flow reserve (FFRcath) measurement during invasive coronary angiography (CAG) results in improved patient outcome and reduced healthcare costs. FFR can now be computed non-invasively from standard coronary CT angiography (cCTA) scans (FFRCT). The purpose of this study is to determine the potential impact of non-invasive FFRCT on costs and clinical outcomes of patients with suspected coronary artery disease in Japan. Clinical data from 254 patients in the HeartFlowNXT trial, costs of goods and services in Japan, and clinical outcome data from the literature were used to estimate the costs and outcomes of 4 clinical pathways: (1) CAG-visual guided PCI, (2) CAG-FFRcath guided PCI, (3) cCTA followed by CAG-visual guided PCI, (4) cCTA-FFRCT guided PCI. The CAG-visual strategy demonstrated the highest projected cost ($10,360) and highest projected 1-year death/myocardial infarction rate (2.4 %). An assumed price for FFRCT of US $2,000 produced equivalent clinical outcomes (death/MI rate: 1.9 %) and healthcare costs ($7,222) for the cCTA-FFRCT strategy and the CAG-FFRcath guided PCI strategy. Use of the cCTA-FFRCT strategy to select patients for PCI would result in 32 % lower costs and 19 % fewer cardiac events at 1 year compared to the most commonly used CAG-visual strategy. Use of cCTA-FFRCT to select patients for CAG and PCI may reduce costs and improve clinical outcome in patients with suspected coronary artery disease in Japan.
Highlights
Prior studies have shown clinical and economic benefits from assessing and utilizing invasive fractional flow reserve (FFRcath) measurements to guide percutaneous coronary intervention (PCI)
In the randomized controlled fractional flow reserve versus angiography for multivessel evaluation (FAME) study including 1,005 patients, it was demonstrated that deferring Percutaneous coronary intervention (PCI) in vessels not associated with myocardial ischemia based on FFRcath resulted in improved clinical outcomes and lower costs [1, 2]
Multicenter, validation studies have been performed
Summary
Prior studies have shown clinical and economic benefits from assessing and utilizing invasive fractional flow reserve (FFRcath) measurements to guide percutaneous coronary intervention (PCI). In the randomized controlled fractional flow reserve versus angiography for multivessel evaluation (FAME) study including 1,005 patients, it was demonstrated that deferring PCI in vessels not associated with myocardial ischemia based on FFRcath resulted in improved clinical outcomes and lower costs [1, 2]. Good concordance between FFRCT and FFRcath was found with high diagnostic accuracy of FFRCT for the detection or exclusion of hemodynamically significant stenosis using FFR B0.80 as the reference standard
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