title: Cost analysis of non-invasive fractional flow reserve derived from coronary computed tomographic angiography in Japan.
abstract: Percutaneous coronary intervention (PCI) based on fractional flow reserve (FFRcath) measurement during invasive coronary angiography (CAG) results in improved patient outcome and reduced healthcare costs. FFR can now be computed non-invasively from standard coronary CT angiography (cCTA) scans (FFRCT). The purpose of this study is to determine the potential impact of non-invasive FFRCT on costs and clinical outcomes of patients with suspected coronary artery disease in Japan. Clinical data from 254 patients in the HeartFlowNXT trial, costs of goods and services in Japan, and clinical outcome data from the literature were used to estimate the costs and outcomes of 4 clinical pathways: (1) CAG-visual guided PCI, (2) CAG-FFRcath guided PCI, (3) cCTA followed by CAG-visual guided PCI, (4) cCTA-FFRCT guided PCI. The CAG-visual strategy demonstrated the highest projected cost ($10,360) and highest projected 1-year death/myocardial infarction rate (2.4 %). An assumed price for FFRCT of US $2,000 produced equivalent clinical outcomes (death/MI rate: 1.9 %) and healthcare costs ($7,222) for the cCTA-FFRCT strategy and the CAG-FFRcath guided PCI strategy. Use of the cCTA-FFRCT strategy to select patients for PCI would result in 32 % lower costs and 19 % fewer cardiac events at 1 year compared to the most commonly used CAG-visual strategy. Use of cCTA-FFRCT to select patients for CAG and PCI may reduce costs and improve clinical outcome in patients with suspected coronary artery disease in Japan.
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan, taketaka@kuhp.kyoto-u.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.forename: Sachio
authors.initials: S
authors.lastname: Kuribayashi
authors.forename: Takaaki
authors.initials: T
authors.lastname: Isshiki
authors.forename: Susumu
authors.initials: S
authors.lastname: Kanazawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Shunya
authors.initials: S
authors.lastname: Ikeda
authors.forename: Ben
authors.initials: B
authors.lastname: Forrest
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Zarins
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hlatky
authors.forename: Bjarne L
authors.initials: BL
authors.lastname: Norgaard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000191:economics*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000191:economics*; D003365:Costs and Cost Analysis; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000191:economics*