Author(s): Nam J., Briggs A., Layland J., Oldroyd K., Curzen N., Sood A., Balachandran K., Das R., Junejo S., Eteiba H., Petrie M., Lindsay M., Watkins S., Mcentegart M., Corbett S., O'Rourke B., Lee M., O'Donnell A., McConnachie A., Henderson R., Berry C.
Abstract: Aims: To assess the cost-effectiveness of routine invasive management with functional assessment of coronary artery disease severity using fractional flow reserve (FFR) vs. standard invasive management without FFR in patients with a recent non-ST elevation myocardial infarction (NSTEMI). Methods and results: We undertook an economic evaluation nested within the randomised controlled trial along with literature input. The results of FAMOUS-NSTEMI have been recently published (Layland et al. Eur Heart J 2014). Part I of the economic analysis used raw, unadjusted resources costs and QALYs from FAMOUS RCT. Part II modelled the effect pathway of FFR by conditioning total costs and QALYs on the treatment decision, using statistical modelling. Results were then applied to treatment decision distributions following FFR or standard care management. FFR reduced revascularisation by PCI or CABG (OR 0.52; 95% CI: 0.28 - 0.94; p=0.022). Part I: FFR led to a mean cost savings (-350 [-1,366 to 672]). Likely drivers of cost savings are length of stay (-331 [-1,002 to 356]) and index year health events (-217 [-712 to 226]). However, low information size contributed to their large imprecision. Incremental QALYs were comparable (0.012 [-0.034 to 0.059]). Part II: uncertainty was reduced in both incremental cost (-204 [-797 to 398]) and incremental QALYs (-0.005 [-0.015 to 0.001]). Uncertainty in cost-effectiveness over common willingness-to-pay remained modest (~25%-30%). Conclusions: Early evidence suggests that compared with standard invasive management without FFR, routine adoption of FFR may be cost saving and comparable in QALYs. However, considerable uncertainty persists. We prescribe specific design considerations for a larger future Phase 3 trial, including increased information size, follow-up frequency and outcomes to aid modelling/lifetime extrapolation.
Conference Information: EuroPCR 2015 Paris France. Conference Start: 20150519 Conference End: 20150522
Publication Type: Journal: Conference Abstract