Cost analysis of non-invasive fractional flow reserve derived from coronary computed tomographic angiography in Japan
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ORIGINAL ARTICLE
Cost analysis of non-invasive fractional flow reserve derived from coronary computed tomographic angiography in Japan Takeshi Kimura • Hiroki Shiomi • Sachio Kuribayashi • Takaaki Isshiki • Susumu Kanazawa • Hiroshi Ito • Shunya Ikeda • Ben Forrest • Christopher K. Zarins Mark A. Hlatky • Bjarne L. Norgaard
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Received: 12 May 2014 / Accepted: 26 June 2014 / Published online: 17 July 2014 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2014
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.
T. Kimura (&) H. Shiomi Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan e-mail: [email protected]
S. Ikeda International University of Health and Welfare, Tokyo, Japan B. Forrest C. K. Zarins HeartFlow, Inc., Redwood City, CA, USA
S. Kuribayashi Department of Radiology, Keio University School of Medicine, Tokyo, Japan
M. A. Hlatky Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
T. Isshiki Department of Cardiology, Teikyo University Hospital, Tokyo, Japan
B. L. Norgaard Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
S. Kanazawa Departments of Radiology, Okayama University Graduate School of Medicine, Okayama, Japan H. Ito Departments of Cardiology, Okayama University Graduate School of Medicine, Okayama, Japan
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Keywords Fractional flow reserve Non-invasive diagnosis Cost-effectiveness Computational fluid dynamics Coronary computed tomographic
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