title: Projected costs and consequences of computed tomography-determined fractional flow reserve.
abstract: BACKGROUND
  Randomized trials have shown that fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) improves clinical outcome and reduces costs compared with visually guided PCI. FFR has been measured during invasive coronary angiography (ICA), but can now be derived noninvasively from coronary computed tomography (CT) angiography (cCTA) images (FFRCT ). The potential value of FFRCT in clinical decision making is unknown.
  
  
  OBJECTIVE
  Use of FFRCT can reduce costs and improve outcomes among patients with suspected coronary artery disease.
  
  
  METHODS
  We used clinical data from 96 patients in the DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study and outcomes data from the literature to project the initial management costs and 1-year death/myocardial infarction rates associated with 5 clinical strategies: (1) ICA with PCI based on visual angiographic assessment, (2) ICA with FFRICA -guided PCI, (3) cCTA followed by ICA and PCI based on visual assessment, (4) cCTA followed by ICA with FFRICA -guided PCI, and (5) cCTA FFRCT and PCI of lesions with FFRCT ≤0.80.
  
  
  RESULTS
  The projected initial management costs were highest for the ICA/visual strategy ($10 702), and lowest for the cCTA/FFRCT /ICA strategy ($7674). The use of FFRCT to select patients for ICA and PCI would result in 30% lower costs and 12% fewer events at 1 year compared with the most commonly used ICA/visual strategy.
  
  
  CONCLUSIONS
  A strategy of using FFRCT to guide the selection of patients for ICA and PCI might reduce costs and improve clinical outcomes in patients with suspected coronary artery disease.
authors.affiliation: Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hlatky
authors.forename: Akshay
authors.initials: A
authors.lastname: Saxena
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
authors.forename: Andrejs
authors.initials: A
authors.lastname: Erglis
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Zarins
authors.forename: James K
authors.initials: JK
authors.lastname: Min
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000191:economics* / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D005544:Forecasting; D053805:Fractional Flow Reserve, Myocardial; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000191:economics; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000191:economics*