PLATFORM: FFRCT Reduces Costs Compared With Invasive Coronary Angiography
The use of fractional flow reserve derived from CT angiography (FFRCT) is associated with lower costs vs. invasive coronary angiography and with greater improvement in quality of life vs. usual non-invasive testing in symptomatic patients with intermediate probability of CAD, according to an analysis of the PLATFORM study presented at TCT 2015 and published simultaneously in the Journal of the American College of Cardiology.
“There are many choices for evaluating patients who have stable new-onset chest pain, and we’re not certain which is the optimal approach,” said Mark A. Hlatky, MD, of Stanford University School of Medicine, Stanford, Calif. In previously presented results, PLATFORM demonstrated that use of FFRCT was associated with a 61% reduction in the rate of invasive angiography without a finding of obstructive CAD.
PLATFORM enrolled patients with stable symptoms and no established CAD diagnosis who were referred for planned invasive or noninvasive evaluation at 11 European centers. In the planned invasive group, 187 patients received usual care and 193 underwent FFRCT; in the planned noninvasive group, the usual-care and FFRCT groups had 100 and 104 patients, respectively.
The use of FFRCT was associated with significantly lower costs over 90 days compared with usual care in the invasive group, but not in the noninvasive group (Figure). In the planned invasive group, diagnostic angiography was used in fewer patients in the first 90 days after FFRCT vs. usual care (37 vs. 153); relatively similar numbers of patients underwent PCI (51 vs. 44).
Because there is no Medicare cost-weight yet for FFRCT, the primary analysis used $0 to estimate cost offsets, Hlatky said. Using that cost offset, usual care had an average cost of $10,734 and FFRCT had a cost of $7,343 in the planned invasive group (P < .0001). This remained true even when FFRCT was weighted at seven times the cost of CTA ($10,734 vs. $8,619; P < .0001).
For noninvasive patients, there was no difference when a cost offset $0 was used, with a cost of $2,137 for usual care and $2,679 for FFRCT (P = .26). When a cost offset of 0.5 times CTA was used, usual care was significantly cheaper ($2,137 vs. $2,766; P = .02).
In patients with planned noninvasive evaluation, quality of life improved more from baseline to 90 days with FFRCT. The Seattle Angina Questionnaire score improved by 19.5 in the FFRCT group and by 11.4 in the usual-care patients (P = .003). EQ-5D showed similar results, though visual analogue scale improvements were no different. There was no difference between FFRCT and usual care in the improvement in quality of life for the planned-invasive patients (P = .54).
Hlatky noted that the study was limited by its nonrandomized, unblinded design. Still, Hlatky said, “these results suggest that use of FFRCT might reduce overall costs and improve patient quality of life.”
- Hlatky reports receiving grant/research support from HeartFlow; consulting fees/honoraria from Acumen, Blue Cross Blue Shield and the Journal of the American College of Cardiology; and royalty income from Up-to-Date.