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Long-Term Cost-Effectiveness of Fractional Flow Reserve-Based Percutaneous Coronary Intervention in Stable and

David Hong1, Hyunsoo Kim2,3, Hankil Lee4

  • 1Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

JACC. Advances
|June 28, 2024
PubMed

Insights

Fractional flow reserve (FFR)-based percutaneous coronary intervention (PCI) is more cost-effective than angiography-based PCI, improving quality of life and reducing adverse events. This approach offers significant long-term economic benefits across different healthcare systems.

Area of Science:

  • Cardiovascular Medicine
  • Health Economics
  • Interventional Cardiology

Background:

  • Limited research exists on the cost-effectiveness of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared to traditional angiography-guided PCI.
  • Understanding the long-term economic implications of FFR-based PCI is crucial for clinical decision-making and healthcare resource allocation.

Purpose of the Study:

  • To evaluate the long-term cost-effectiveness of FFR-based PCI versus angiography-based PCI.
  • To assess the impact of FFR-based PCI on patient outcomes and healthcare costs in a nationwide cohort.

Main Methods:

  • A cost-effectiveness analysis was performed using nationwide Korean healthcare data (NHIS-HIRA) and a decision/Markov model incorporating US and UK healthcare system values.
  • The study analyzed a cohort of patients with stable or unstable angina undergoing PCI.
  • Incremental Cost-Effectiveness Ratio (ICER) was calculated to determine the cost per additional quality-adjusted life-year (QALY) gained.

Main Results:

  • FFR-based PCI was associated with significantly lower risks of all-cause death and spontaneous myocardial infarction at 4 years compared to angiography-based PCI.
  • In Korea, FFR-based PCI demonstrated cost-effectiveness, gaining QALYs at a lower cost (ICER: -$7,748) over 4 years.
  • FFR-based PCI proved dominant across Korean, US, and UK healthcare systems over a 10-year horizon, with consistently favorable ICERs in sensitivity analyses.

Conclusions:

  • FFR-based PCI is associated with improved quality of life and reduced costs compared to angiography-based PCI.
  • FFR-guided PCI is a cost-effective strategy for patients with stable or unstable angina undergoing PCI, offering significant economic advantages.
Abstract

Keywords:
angina pectoriscost-effectivenessfractional flow reservepercutaneous coronary intervention

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