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Instantaneous wave-free ratio compared with fractional flow reserve in PCI: A cost-minimization analysis

Karolina Berntorp1, Josefine Persson2, Sasha M Koul1

  • 1Department of Cardiology, Lund University, Skåne University Hospital, Lund, Sweden.

International Journal of Cardiology
|October 3, 2021
PubMed

Insights

Instantaneous wave-free ratio (iFR) guided revascularization offers significant cost savings compared to fractional flow reserve (FFR) guided procedures. This cost-minimization analysis confirms iFR as a more economical approach for guiding coronary revascularization.

Area of Science:

  • Cardiology
  • Health Economics
  • Interventional Cardiology

Background:

  • Coronary physiology assessment is crucial for guiding revascularization decisions.
  • The iFR-SWEDEHEART trial showed comparable clinical outcomes for iFR versus FFR.
  • Previous research highlighted the need for cost-effectiveness analysis in guiding revascularization.

Purpose of the Study:

  • To conduct a cost-minimization analysis comparing iFR-guided versus FFR-guided coronary revascularization.
  • To evaluate the economic impact of using iFR versus FFR from a healthcare perspective.
  • To determine cost differences in Nordic and US healthcare settings.

Main Methods:

  • A decision-tree model with a one-year time horizon was utilized.
  • Data on treatment pathways and healthcare utilization were sourced from the iFR-SWEDEHEART trial.
  • Unit costs for procedures and outcomes were derived from Nordic and US healthcare data.

Main Results:

  • iFR-guided revascularization resulted in cost savings of $681 per patient in the Nordic setting and $1024 in the US setting.
  • Sensitivity analyses confirmed the robustness of the cost-saving findings.
  • The economic benefits of iFR were consistent across different healthcare settings.

Conclusions:

  • iFR-guided revascularization presents a significant cost-saving alternative to FFR-guided procedures.
  • The findings support the adoption of iFR for more economical coronary revascularization strategies.
  • Implementing iFR can lead to substantial reductions in healthcare expenditure for coronary interventions.
Abstract

Keywords:
Cost-minimization analysisFractional flow reserveInstantaneous wave-free ratio

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