Uwe Siebert1, Marjan Arvandi2, Raffaella M Gothe2, Bernhard Bornschein2, David Eccleston3, Darren L Walters4, James Rankin5, Bernard De Bruyne6, William F Fearon7, Nico H Pijls8, Richard Harper9. 1. Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Hall i.T., Austria; Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA; Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: uwe.siebert@umit.at. 2. Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Hall i.T., Austria. 3. Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia. 4. Cardiology, The Prince Charles Hospital, University of Queensland, Brisbane, Australia. 5. Cardiology, Royal Perth Hospital, Perth, Australia. 6. Cardiovascular Center Aalst, Aalst, Belgium. 7. Cardiovascular Institute, University Medical Center, Stanford, CA, USA. 8. Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands. 9. Monash Heart, Monash Medical Centre, Monash University, Melbourne, Australia.
Abstract
PURPOSE: The international multicentre FAME Study (n=1,005) demonstrated significant health benefits for patients undergoing multivessel percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) measurement compared with angiography guidance alone (ANGIO). We determined the cost-effectiveness and the public health/budget impact for Australia. METHODS: We performed a prospective economic evaluation comparing FFR vs. ANGIO in patients with multivessel disease based on original patient-level FAME data. We used Australian utilities (EQ-5D) and costs to calculate quality-adjusted life years (QALYs) and incremental cost-effectiveness adopting the societal perspective. The public health and budget impact from the payer's perspective was based on Australian PCI registries. Uncertainty was explored using deterministic sensitivity analyses and the bootstrap method (n=5,000 samples). RESULTS: The cost-effectiveness analysis showed that FFR was cost-saving and reduces costs by 1,776 AUD per patient during one year. Over a two-year time horizon, the public health impact ranged from 7.8 to 73.9 QALYs gained and the budget impact from 1.8 to 14.5 million AUD total cost savings. Sensitivity analyses demonstrated that FFR was cost-saving over a wide range of assumptions. CONCLUSIONS: FFR-guided PCI in patients with multivessel coronary disease substantially reduces cardiac events, improves QALYs and is cost-saving in the Australian health care system.
PURPOSE: The international multicentre FAME Study (n=1,005) demonstrated significant health benefits for patients undergoing multivessel percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) measurement compared with angiography guidance alone (ANGIO). We determined the cost-effectiveness and the public health/budget impact for Australia. METHODS: We performed a prospective economic evaluation comparing FFR vs. ANGIO in patients with multivessel disease based on original patient-level FAME data. We used Australian utilities (EQ-5D) and costs to calculate quality-adjusted life years (QALYs) and incremental cost-effectiveness adopting the societal perspective. The public health and budget impact from the payer's perspective was based on Australian PCI registries. Uncertainty was explored using deterministic sensitivity analyses and the bootstrap method (n=5,000 samples). RESULTS: The cost-effectiveness analysis showed that FFR was cost-saving and reduces costs by 1,776 AUD per patient during one year. Over a two-year time horizon, the public health impact ranged from 7.8 to 73.9 QALYs gained and the budget impact from 1.8 to 14.5 million AUD total cost savings. Sensitivity analyses demonstrated that FFR was cost-saving over a wide range of assumptions. CONCLUSIONS: FFR-guided PCI in patients with multivessel coronary disease substantially reduces cardiac events, improves QALYs and is cost-saving in the Australian health care system.
Authors: Ojas Hrakesh Mehta; Michael Hay; Ren Yik Lim; Abdul Rahman Ihdayhid; Michael Michail; Jun Michael Zhang; James D Cameron; Dennis T L Wong Journal: Cardiovasc Diagn Ther Date: 2020-06