Cost-effectiveness of measuring fractional flow reserve to guide coronary interventions

American Heart Journal
William F FearonPaul A Heidenreich

Abstract

Most patients come to the catheterization laboratory without prior functional tests, which makes the cost-effective treatment of patients with intermediate coronary lesions a practical challenge. We developed a decision model to compare the long-term costs and benefits of 3 strategies for treating patients with an intermediate coronary lesion and no prior functional study: 1) deferring the decision for percutaneous coronary intervention (PCI) to obtain a nuclear stress imaging study (NUC strategy); 2) measuring fractional flow reserve (FFR) at the time of angiography to help guide the decision for PCI (FFR strategy); and 3) stenting all intermediate lesions (STENT strategy). On the basis of the literature, we estimated that 40% of intermediate lesions would produce ischemia, 70% of patients treated with PCI and 30% of patients treated medically would be free of angina after 4 years, and the quality-of-life adjustment for living with angina was 0.9 (1.0 = perfect health). We estimated the cost of FFR to be 761 dollars, the cost of nuclear stress imaging to be 1093 dollars, and the cost of medical treatment for angina to be 1775 dollars per year. The extra cost of splitting the angiogram and PCI as dictated by the NUC strategy wa...Continue Reading

References

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Citations

Jan 8, 2008·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·S A J ChamuleauJ J Piek
Jan 17, 2015·Texas Heart Institute Journal·Bashar HannawiGeorge A Younis
Apr 24, 2008·Implementation Science : IS·Mark W Smith, Paul G Barnett
May 7, 2010·The International Journal of Cardiovascular Imaging·Hansel J OteroPeter J Neumann
Jan 1, 2009·ClinicoEconomics and Outcomes Research : CEOR·Ceri J Phillips, Ioan Humphreys
Jun 19, 2007·Acute Cardiac Care·Edo KaluskiMorris Mosseri
Dec 8, 2009·Cardiology Clinics·Narbeh MelikianCarlo Di Mario
Mar 22, 2014·Clinical Cardiology·Islam Y ElgendyAnthony A Bavry
Oct 18, 2014·Journal of the American College of Cardiology·John McB Hodgson
Jul 26, 2008·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Jacques J Koolen, Nico H J Pijls
Sep 1, 2004·Journal of the American College of Cardiology·Harlan M Krumholz
Nov 7, 2006·Journal of the American College of Cardiology·William F Fearon
May 3, 2016·Korean Journal of Radiology : Official Journal of the Korean Radiological Society·Doyeon HwangBon-Kwon Koo
Dec 15, 2010·Archives of Cardiovascular Diseases·Étienne PuymiratMartine Gilard
Aug 31, 2006·Circulation·Morton J KernUNKNOWN American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiolog
Dec 4, 2010·Circulation·William F FearonUNKNOWN Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) Study Investigators
Feb 28, 2017·PloS One·Tomasz ZaprutkoElżbieta Nowakowska
Dec 3, 2010·PLoS Medicine·Jan H F RemmeRobert F Terry
Dec 24, 2018·International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care·Steffan Frosi StellaUwe Siebert

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