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Published on: April 13, 2015
Cost-effectiveness of Fractional Flow Reserve Versus Intravascular Ultrasound to Guide Percutaneous Coronary
Doyeon Hwang1, Hea-Lim Kim2, Jane Ko2
1Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Insights
Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is more cost-effective than intravascular ultrasound (IVUS)-guided PCI for intermediate coronary lesions in Korea. This strategy reduces lifetime healthcare costs and improves quality-adjusted life-years (QALYs).
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Interventional Cardiology
Background:
- The FLAVOUR trial established non-inferiority of FFR-guided PCI versus IVUS-guided PCI for intermediate coronary stenosis.
- Cost-effectiveness of these strategies in the Korean healthcare system remained unevaluated.
Purpose of the Study:
- To assess the cost-effectiveness of FFR-guided PCI compared to IVUS-guided PCI in Korea.
- To analyze lifetime healthcare costs and quality-adjusted life-years (QALYs) from a healthcare system perspective.
Main Methods:
- A two-part cost-effectiveness model (decision tree and Markov model) was developed.
- Data from the FLAVOUR trial informed transition probabilities, while Korean National Health Insurance claims data provided cost information.
- Health utilities were derived from the Seattle Angina Questionnaire mapped to EQ-5D.
Main Results:
- FFR-guided PCI demonstrated lower lifetime healthcare costs (by $2,451 USD) and higher QALYs (by 0.178) compared to IVUS-guided PCI.
- Probabilistic sensitivity analysis indicated FFR-guided PCI's cost-effectiveness across various willingness-to-pay thresholds.
Conclusions:
- FFR-guided PCI is projected to be a dominant strategy in Korea for intermediate coronary lesions.
- This approach offers both reduced lifetime healthcare costs and improved patient outcomes (QALYs).
Background And Objectives:
The Fractional Flow Reserve and Intravascular Ultrasound-Guided Intervention Strategy for Clinical Outcomes in Patients with Intermediate Stenosis (FLAVOUR) trial demonstrated non-inferiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with intravascular ultrasound (IVUS)-guided PCI. We sought to investigate the cost-effectiveness of FFR-guided PCI compared to IVUS-guided PCI in Korea.
Methods:
A 2-part cost-effectiveness model, composed of a short-term decision tree model and a long-term Markov model, was developed for patients who underwent PCI to treat intermediate stenosis (40% to 70% stenosis by visual estimation on coronary angiography). The lifetime healthcare costs and quality-adjusted life-years (QALYs) were estimated from the healthcare system perspective. Transition probabilities were mainly referred from the FLAVOUR trial, and healthcare costs were mainly obtained through analysis of Korean National Health Insurance claims data. Health utilities were mainly obtained from the Seattle Angina Questionnaire responses of FLAVOUR trial participants mapped to EQ-5D.
Results:
From the Korean healthcare system perspective, the base-case analysis showed that FFR-guided PCI was 2,451 U.S. dollar lower in lifetime healthcare costs and 0.178 higher in QALYs compared to IVUS-guided PCI. FFR-guided PCI remained more likely to be cost-effective over a wide range of willingness-to-pay thresholds in the probabilistic sensitivity analysis.
Conclusions:
Based on the results from the FLAVOUR trial, FFR-guided PCI is projected to decrease lifetime healthcare costs and increase QALYs compared with IVUS-guided PCI in intermediate coronary lesion, and it is a dominant strategy in Korea.
Trial Registration:
ClinicalTrials.gov Identifier: NCT02673424.
