Economic Evaluation of Fractional Flow Reserve–Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease

  • William F. Fearon
    From the Stanford University Medical Center, Stanford, Calif (W.F.F.); University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria (B.B., R.M.G., U.S.); Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Aalst, Belgium (B.D.B.); and Massachusetts General Hospital, Harvard Medical School, Boston (U.S.).
  • Bernhard Bornschein
    From the Stanford University Medical Center, Stanford, Calif (W.F.F.); University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria (B.B., R.M.G., U.S.); Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Aalst, Belgium (B.D.B.); and Massachusetts General Hospital, Harvard Medical School, Boston (U.S.).
  • Pim A.L. Tonino
    From the Stanford University Medical Center, Stanford, Calif (W.F.F.); University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria (B.B., R.M.G., U.S.); Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Aalst, Belgium (B.D.B.); and Massachusetts General Hospital, Harvard Medical School, Boston (U.S.).
  • Raffaella M. Gothe
    From the Stanford University Medical Center, Stanford, Calif (W.F.F.); University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria (B.B., R.M.G., U.S.); Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Aalst, Belgium (B.D.B.); and Massachusetts General Hospital, Harvard Medical School, Boston (U.S.).
  • Bernard De Bruyne
    From the Stanford University Medical Center, Stanford, Calif (W.F.F.); University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria (B.B., R.M.G., U.S.); Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Aalst, Belgium (B.D.B.); and Massachusetts General Hospital, Harvard Medical School, Boston (U.S.).
  • Nico H.J. Pijls
    From the Stanford University Medical Center, Stanford, Calif (W.F.F.); University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria (B.B., R.M.G., U.S.); Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Aalst, Belgium (B.D.B.); and Massachusetts General Hospital, Harvard Medical School, Boston (U.S.).
  • Uwe Siebert
    From the Stanford University Medical Center, Stanford, Calif (W.F.F.); University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria (B.B., R.M.G., U.S.); Catharina Hospital, Eindhoven, the Netherlands (P.A.L.T., N.H.J.P.); Cardiovascular Center Aalst, Aalst, Belgium (B.D.B.); and Massachusetts General Hospital, Harvard Medical School, Boston (U.S.).

説明

<jats:sec> <jats:title>Background—</jats:title> <jats:p>The Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study demonstrated significantly improved health outcomes at 1 year in patients randomized to multivessel percutaneous coronary intervention guided by fractional flow reserve (FFR) compared with percutaneous coronary intervention guided by angiography alone. The economic impact of routine measurement of FFR in this setting is not known.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p> In this study, 1005 patients were randomly assigned to FFR-guided or angiography-guided percutaneous coronary intervention and followed up for 1 year. A prospective cost-utility analysis comparing costs and quality-adjusted life-years was performed with a time horizon of 1 year. Quality-adjusted life-years were calculated with the use of utilities determined by the EuroQuol 5 dimension health survey with US weights. Direct medical costs included those of the index procedure and hospitalization and costs for major adverse cardiac events during follow-up. Confidence intervals for both quality-adjusted life-years and costs were estimated by the bootstrap percentile method. Major adverse cardiac events at 1 year occurred in 13.2% of those in the FFR-guided arm and 18.3% of those in the angiography-guided arm ( <jats:italic>P</jats:italic> =0.02). Quality-adjusted life-years were slightly greater in the FFR-guided arm (0.853 versus 0.838; <jats:italic>P</jats:italic> =0.2). Mean overall costs at 1 year were significantly less in the FFR-guided arm ($14 315 versus $16 700; <jats:italic>P</jats:italic> <0.001). Bootstrap simulation indicated that the FFR-guided strategy was cost-saving in 90.74% and cost-effective at a threshold of US $50 000 per quality-adjusted life-years in 99.96%. Sensitivity analyses demonstrated robust results. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion—</jats:title> <jats:p>Economic evaluation of the FAME study reveals that FFR-guided percutaneous coronary intervention in patients with multivessel coronary disease is one of those rare situations in which a new technology not only improves outcomes but also saves resources.</jats:p> </jats:sec> <jats:sec> <jats:title>Clinical Trial Registration—</jats:title> <jats:p> URL: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://ClinicalTrials.gov">http://ClinicalTrials.gov</jats:ext-link> . Unique identifier: NCT00267774. </jats:p> </jats:sec>

収録刊行物

  • Circulation

    Circulation 122 (24), 2545-2550, 2010-12-14

    Ovid Technologies (Wolters Kluwer Health)

被引用文献 (11)*注記

もっと見る

詳細情報 詳細情報について

問題の指摘

ページトップへ