Cost-effectiveness of percutaneous coronary intervention in patients with stable coronary artery disease and abnormal fractional flow reserve
William F Fearon, David Shilane, Nico H J Pijls, Derek B Boothroyd, Pim A L Tonino, Emanuele Barbato, Peter Jüni, Bernard De Bruyne, Mark A Hlatky, Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 2 (FAME 2) Investigators, William F Fearon, David Shilane, Nico H J Pijls, Derek B Boothroyd, Pim A L Tonino, Emanuele Barbato, Peter Jüni, Bernard De Bruyne, Mark A Hlatky, Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 2 (FAME 2) Investigators
Abstract
Background: The Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) 2 trial demonstrated a significant reduction in subsequent coronary revascularization among patients with stable angina and at least 1 coronary lesion with a fractional flow reserve ≤0.80 who were randomized to percutaneous coronary intervention (PCI) compared with best medical therapy. The economic and quality-of-life implications of PCI in the setting of an abnormal fractional flow reserve are unknown.
Methods and results: We calculated the cost of the index hospitalization based on initial resource use and follow-up costs based on Medicare reimbursements. We assessed patient utility using the EQ-5D health survey with US weights at baseline and 1 month and projected quality-adjusted life-years assuming a linear decline over 3 years in the 1-month utility improvements. We calculated the incremental cost-effectiveness ratio based on cumulative costs over 12 months. Initial costs were significantly higher for PCI in the setting of an abnormal fractional flow reserve than with medical therapy ($9927 versus $3900, P<0.001), but the $6027 difference narrowed over 1-year follow-up to $2883 (P<0.001), mostly because of the cost of subsequent revascularization procedures. Patient utility was improved more at 1 month with PCI than with medical therapy (0.054 versus 0.001 units, P<0.001). The incremental cost-effectiveness ratio of PCI was $36 000 per quality-adjusted life-year, which was robust in bootstrap replications and in sensitivity analyses.
Conclusions: PCI of coronary lesions with reduced fractional flow reserve improves outcomes and appears economically attractive compared with best medical therapy among patients with stable angina.
Trial registration: ClinicalTrials.gov NCT01132495.
Keywords: coronary disease; fractional flow reserve, myocardial; percutaneous coronary intervention.
Source: PubMed