title: Improving the quality of percutaneous revascularisation in patients with multivessel disease in Australia: cost-effectiveness, public health implications, and budget impact of FFR-guided PCI.
abstract: OBJECTIVE
  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.affiliation: 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.
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert
authors.affiliation: Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Hall i.T., Austria.
authors.forename: Marjan
authors.initials: M
authors.lastname: Arvandi
authors.affiliation: Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Hall i.T., Austria.
authors.forename: Raffaella M
authors.initials: RM
authors.lastname: Gothe
authors.affiliation: Department of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Hall i.T., Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Bornschein
authors.affiliation: Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Eccleston
authors.affiliation: Cardiology, The Prince Charles Hospital, University of Queensland, Brisbane, Australia.
authors.forename: Darren L
authors.initials: DL
authors.lastname: Walters
authors.affiliation: Cardiology, Royal Perth Hospital, Perth, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Rankin
authors.affiliation: Cardiovascular Center Aalst, Aalst, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.affiliation: Cardiovascular Institute, University Medical Center, Stanford, CA, USA.
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
authors.affiliation: Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
authors.forename: Nico H
authors.initials: NH
authors.lastname: Pijls
authors.affiliation: Monash Heart, Monash Medical Centre, Monash University, Melbourne, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Harper
mesh_terms: D001315:Australia; D017023:Coronary Angiography / Q000191:economics* / Q000379:methods; D003324:Coronary Artery Disease / Q000191:economics* / Q000601:surgery*; D003365:Costs and Cost Analysis; D062645:Percutaneous Coronary Intervention / Q000191:economics* / Q000379:methods
keywords: Coronary artery disease; Cost-benefit analysis; Flow reserve; Multivessel disease; Percutaneous coronary intervention (PCI)