Cost analysis of non-invasive fractional flow reserve derived from coronary computed tomographic angiography in Japan
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Published on: August 25, 2023
Takeshi Kimura1, Hiroki Shiomi, Sachio Kuribayashi
1Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan, taketaka@kuhp.kyoto-u.ac.jp.
Insights
Non-invasive computed fractional flow reserve (FFRCT) from CT angiography can significantly lower costs and reduce cardiac events in suspected coronary artery disease patients in Japan. This approach offers improved outcomes compared to traditional methods.
Area of Science:
- Cardiovascular Imaging
- Health Economics
- Interventional Cardiology
Background:
- Fractional flow reserve (FFR) measured during invasive coronary angiography (CAG) improves outcomes and reduces costs.
- Non-invasive FFR computation from coronary CT angiography (FFRCT) is now available.
- The economic and clinical impact of FFRCT in Japan requires evaluation.
Purpose of the Study:
- To assess the potential impact of non-invasive FFRCT on healthcare costs and clinical outcomes.
- To compare four clinical pathways for managing suspected coronary artery disease in Japan.
Main Methods:
- Utilized clinical data from the HeartFlowNXT trial (254 patients).
- Incorporated Japanese cost data and literature-based clinical outcomes.
- Modeled four strategies: CAG-visual PCI, CAG-FFRcath guided PCI, cCTA with CAG-visual PCI, and cCTA-FFRCT guided PCI.
Main Results:
- The CAG-visual strategy had the highest projected cost ($10,360) and 1-year death/myocardial infarction (MI) rate (2.4%).
- At an FFRCT price of $2,000, the cCTA-FFRCT strategy achieved comparable outcomes (1.9% death/MI) and costs ($7,222) to CAG-FFRcath.
- The cCTA-FFRCT strategy projected 32% lower costs and 19% fewer cardiac events at 1 year versus CAG-visual PCI.
Conclusions:
- Non-invasive FFRCT has the potential to reduce healthcare costs and improve clinical outcomes for patients with suspected coronary artery disease in Japan.
- Implementing FFRCT for patient selection for CAG and PCI may lead to significant economic and clinical benefits.
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.
