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

Siebert, Uwe, Arvandi, Marjan, Gothe, Raffaella M., Bornschein, Bernhard, Eccleston, David, Walters, Darren L., Rankin, James, De Bruyne, Bernard, Fearon, William F., Pijls, Nico H. and Harper, Richard (2014) 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. Heart Lung and Circulation, 23 6: 527-533. doi:10.1016/j.hlc.2013.12.009


Author Siebert, Uwe
Arvandi, Marjan
Gothe, Raffaella M.
Bornschein, Bernhard
Eccleston, David
Walters, Darren L.
Rankin, James
De Bruyne, Bernard
Fearon, William F.
Pijls, Nico H.
Harper, Richard
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
Journal name Heart Lung and Circulation   Check publisher's open access policy
ISSN 1443-9506
1444-2892
Publication date 2014-06-01
Year available 2014
Sub-type Article (original research)
DOI 10.1016/j.hlc.2013.12.009
Volume 23
Issue 6
Start page 527
End page 533
Total pages 7
Place of publication Chatswood, VIC, Australia
Publisher Elsevier Australia
Collection year 2015
Language eng
Formatted abstract
Purpose

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.
Keyword Coronary artery disease
Flow reserve
Cost-benefit analysis
Percutaneous coronary intervention (PCI)
Multivessel disease
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 4 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 8 times in Scopus Article | Citations
Google Scholar Search Google Scholar
Created: Sun, 27 Jul 2014, 10:05:12 EST by System User on behalf of School of Medicine