Nobuhiro Tanaka1, Shun Kohsaka2, Tatsunori Murata3, Takashi Akasaka4, Kazushige Kadota5, Shirou Uemura6, Tetsuya Amano7, Nobuo Shiode8, Yoshihiro Morino9, Kenshi Fujii10, Yutaka Hikichi11, Masato Nakamura12. 1. Department of Cardiology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan. Electronic address: n-tanaka@tokyo-med.ac.jp. 2. Department of Cardiology, Keio University School of Medicine, Tokyo, Japan. 3. CRECON Medical Assessment Inc., Tokyo, Japan. 4. Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan. 5. Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan. 6. Cardiovascular Medicine, Kawasaki Medical University, Okayama, Japan. 7. Department of Cardiology, Aichi Medical University, Aichi, Japan. 8. Division of Cardiology, Tsuchiya General Hospital, Hiroshima, Japan. 9. Division of Cardiology, Iwate Medical University Hospital, Iwate, Japan. 10. Cardiovascular Center, Sakurabashi Watanabe Hospital, Osaka, Japan. 11. Department of Cardiovascular Medicine, Saga University, Saga, Japan. 12. Division of Cardiovascular Medicine, Ohashi Medical Center, Toho University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) could improve outcome compared with angiography-guided PCI. However, the economic impact of FFR-guided PCI remains largely unknown in the medical system in Japan. We evaluated the impact of treatment strategy modification by FFR measurement on the direct medical cost using a model analysis with a decision tree model in Japan. METHODS: For the clinical parameters set in the model, the findings from CVIT-DEFER registry were adopted. Cost parameters were considered on the assumption that coronary angiography, FFR measurement, and the treatment are performed at Diagnosis Procedure combination (DPC) hospitals, and the costs were calculated based on the medical fee reimbursement systems in Japan. RESULTS: The probability of deferral of PCI in patients who were allocated to PCI based on coronary angiography was set as 90.1% based on the CVIT-DEFER registry. In the model analysis, the cost of tests was increased by 185,660 JPY per patient by the addition of FFR measurement, but the cost of treatment with PCI was reduced by 561,425 JPY per patient, and the entire cost of treatment was reduced by 322,675 JPY, resulting in the expected reduction in the total expected medical cost by 137,015 JPY per patient. CONCLUSION: Under contemporary Japanese practice, FFR-guided PCI has potential to reduce the medical cost by effective reassessment of coronary stenosis and reducing inappropriate application of PCI.
BACKGROUND: Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) could improve outcome compared with angiography-guided PCI. However, the economic impact of FFR-guided PCI remains largely unknown in the medical system in Japan. We evaluated the impact of treatment strategy modification by FFR measurement on the direct medical cost using a model analysis with a decision tree model in Japan. METHODS: For the clinical parameters set in the model, the findings from CVIT-DEFER registry were adopted. Cost parameters were considered on the assumption that coronary angiography, FFR measurement, and the treatment are performed at Diagnosis Procedure combination (DPC) hospitals, and the costs were calculated based on the medical fee reimbursement systems in Japan. RESULTS: The probability of deferral of PCI in patients who were allocated to PCI based on coronary angiography was set as 90.1% based on the CVIT-DEFER registry. In the model analysis, the cost of tests was increased by 185,660 JPY per patient by the addition of FFR measurement, but the cost of treatment with PCI was reduced by 561,425 JPY per patient, and the entire cost of treatment was reduced by 322,675 JPY, resulting in the expected reduction in the total expected medical cost by 137,015 JPY per patient. CONCLUSION: Under contemporary Japanese practice, FFR-guided PCI has potential to reduce the medical cost by effective reassessment of coronary stenosis and reducing inappropriate application of PCI.
Authors: Jin Ho Kim; Woonggil Choi; Ki Chang Kim; Chang Wook Nam; Bum Kee Hong; June Hong Kim; Doo Soo Jeon; Jang Whan Bae; Sang Hyun Kim; Keon Woong Moon; Byung Ryul Cho; Doo Il Kim; Jae Sik Jang Journal: Korean Circ J Date: 2019-06-05 Impact factor: 3.243