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The measurement of fractional flow reserve (FFR) before performing percutaneous coronary intervention (PCI) has increased since the FAME trial showed that FFR guidance reduced adverse-event rates (JW Cardiol Jan 14 2009). The FAME investigators now report the results of a prospective evaluation of the cost-effectiveness of an FFR-guided strategy in a U.S. healthcare-based context. The costs of the index procedures were based on actual resources consumed and costs of hospitalization. The costs of subsequent procedures during 1 year of follow-up were based on Medicare reimbursement rates.
Despite the cost of the FFR pressure wire, initial-procedure costs were lower with FFR guidance than without it ($13,182 vs. $14,878), primarily because fewer drug-eluting stents were used. Costs with FFR guidance remained lower than without it at 1 year ($14,315 vs. $16,700), reflecting the benefit of fewer repeat revascularization procedures. Compared with the no-FFR arm, the FFR arm showed a slight trend toward increased quality-adjusted life-years (QALYs).
Fearon WF et al for the Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) Study Investigators. Economic evaluation of fractional flow reserve guided percutaneous coronary intervention in patients with multivessel disease. Circulation 2010 Dec 14; 122:2545.
Comment
These findings support the use of an FFR-guided strategy with PCI in patients with multivessel coronary artery disease, demonstrating not only improved outcomes (as measured by QALYs) but also cost savings at 1 year. Study limitations include the relatively short follow-up and the application of U.S.-specific costs to procedures that were mostly performed outside the U.S. As the authors note, a new technology that not only improves outcomes but also saves resources is a rare phenomenon. We should encourage the use of FFR to guide decision making in treating moderately severe stenoses during PCI.