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Cost-effectiveness of angiographic quantitative flow ratio-guided coronary intervention: A multicenter, randomized,
Yanyan Zhao1, Changdong Guan2, Yang Wang1
1Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing 100037, China.
Insights
Quantitative flow ratio (QFR) guided percutaneous coronary intervention (PCI) improved clinical outcomes and is cost-effective in China. This novel approach offers economic advantages over standard angiography guidance for PCI procedures.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Interventional Cardiology
Background:
- The FAVOR III China trial showed improved two-year outcomes with quantitative flow ratio (QFR) guided percutaneous coronary intervention (PCI) compared to standard angiography.
- This analysis assesses the cost-effectiveness of QFR-guided PCI within the Chinese healthcare system.
Purpose of the Study:
- To evaluate the economic value of using QFR for lesion selection in PCI.
- To compare the costs and clinical outcomes of QFR-guided versus angiography-guided PCI.
Main Methods:
- A pre-specified analysis of 3825 patients from the FAVOR III China trial, randomized to QFR-guided or angiography-guided PCI.
- Two-year follow-up data on clinical outcomes, quality-adjusted life-years (QALYs), and healthcare costs were collected.
- Incremental cost-effectiveness ratio (ICER) was calculated per major adverse cardiac and cerebrovascular event (MACCE) avoided.
Main Results:
- QFR-guided PCI showed a significantly lower MACCE rate at two years (10.8% vs. 14.7%).
- Total two-year costs were comparable between groups (¥50,803 vs. ¥50,685).
- The ICER for QFR-guided PCI was ¥3055 per MACCE avoided, considered economically attractive.
Conclusions:
- QFR-guided PCI is an economically attractive strategy compared to angiography guidance in China.
- The cost-effectiveness is supported by improved clinical outcomes and comparable costs.
- QFR-guided PCI demonstrates a high probability of being cost-effective at standard willingness-to-pay thresholds.
Background:
The FAVOR (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) III China trial demonstrated that percutaneous coronary intervention (PCI) lesion selection using quantitative flow ratio (QFR) measurement, a novel angiography-based approach for estimating fractional flow reserve, improved two-year clinical outcomes compared with standard angiography guidance. This study aimed to assess the cost-effectiveness of QFR-guided PCI from the perspective of the current Chinese healthcare system.
Methods:
This study is a pre-specified analysis of the FAVOR III China trial, which included 3825 patients randomized between December 25, 2018, and January 19, 2020, from 26 centers in China. Patients with stable or unstable angina pectoris or those ≥72 hours post-myocardial infarction who had at least one lesion with a diameter stenosis between 50% and 90% in a coronary artery with a ≥2.5 mm reference vessel diameter by visual assessment were randomized to a QFR-guided strategy or an angiography-guided strategy with 1:1 ratio. During the two-year follow-up, data were collected on clinical outcomes, quality-adjusted life-years (QALYs), estimated costs of index procedure hospitalization, outpatient cardiovascular medication use, and rehospitalization due to major adverse cardiac and cerebrovascular events (MACCE). The primary analysis calculated the incremental cost-effectiveness ratio (ICER) as the cost per MACCE avoided. An ICER of ¥10,000/MACCE event avoided was considered economically attractive in China.
Results:
At two years, the QFR-guided group demonstrated a reduced rate of MACCE compared to the angiography-guided group (10.8% vs . 14.7%, P <0.01). Total two-year costs were similar between the groups (¥50,803 ± 21,121 vs . ¥50,685 ± 23,495, P = 0.87). The ICER for the QFR-guided strategy was ¥3055 per MACCE avoided, and the probability of QFR being economically attractive was 64% at a willingness-to-pay threshold of ¥10,000/MACCE avoided. Sensitivity analysis showed that QFR-guided PCI would become cost-saving if the cost of QFR were below ¥3682 (current cost: ¥3800). Cost-utility analysis yielded an ICER of ¥56,163 per QALY gained, with a 53% probability of being cost-effective at a willingness-to-pay threshold of ¥85,000 per QALY gained.
Conclusion:
In patients undergoing PCI, a QFR-guided strategy appears economically attractive compared to angiographic guidance from the perspective of the Chinese healthcare system.
Trial Registration:
ClinicalTrials.gov , NCT03656848.
