FFR-Guided Stenting Cost Effective in European Countries

PARIS, France—Using fractional flow reserve (FFR) measurements to guide stenting of patients with multivessel disease saves costs while at the same time improving health outcomes, a rarity for a new technology in cardiovascular medicine, according to a report presented Friday, May 20 at EuroPCR2011.

Researchers led by Uwe Siebert, MD, MPH, MSc, of the University for Health Sciences (Hall, Austria), analyzed the cost-effectiveness of FFR-guided PCI by using patient-level data from the FAME (Fractional flow reserve versus Angiography for Multivessel Evaluation) study, which found that the composite endpoint of death or MI was reduced by 34% with FFR compared with angiography alone in over 1,000 patients.

Despite the positive clinical benefits, Dr. Siebert noted the potential trade-off in terms of cost-effectiveness: namely, FFR must be paid for in all patients, while cost-savings from stents and follow-up care would be achieved in only those patients who avoided PCI.

To address this question in a European context, Dr. Siebert and colleagues used health outcomes, resource utilization, and population data to focus on the cost and health effects of FFR-guided stenting in 4 countries: Germany, United Kingdom, Italy, and France. A previous study demonstrated the technology to be cost-effective at just 1 year in the United States.

The researchers fond that FFR-guidance achieved a high level of overall and per-patient cost-saving and cost-effectiveness compared with angiography alone in each country based on 5,000 simulation samples (table 1).

Table 1. Cost Effects of FFR-Guided Stenting

^a Based only on baseline PCI procedure.

Dr. Siebert explained that the variances in cost savings per patient were primarily due to the different stent prices in each country. On sensitivity analysis, the cost of DES and the pressure wire consistently had the most impact on cost-effectiveness.

The researchers also performed a 2-year health impact analysis estimating the number of deaths and MIs that could be avoided with FFR-guided stenting based on the number of PCI procedures performed per year in each country. For instance, in Germany, where over 300,000 PCI procedures are performed annually, FFR guidance could help avoid about 1,600 death/MIs over 2 years. In France, the number of potential death/MIs avoided was lower (1,000), due to the lower number of PCIs performed each year (about 120,000). In Italy, the number of death/MIs avoided was about 400, and in the UK, about 100.

On a 2-year budget analysis using the same PCI frequency estimates, Dr. Siebert presented data showing that FFR-guidance could save each country millions in health care costs:

• Germany – €14 million
• France – €17 million
• Italy – €4.5 million
• UK – €1.5 million

“In the health care systems of Germany, France, the United Kingdom, and Italy, FFR-guided stenting is cost saving compared to angiography guidance alone in multivessel CAD patients,” Dr. Siebert said. “This is a rare situation in cardiology where a new technology not only prevents MACE and MIs, saves lives, and improves quality of life but also substantially saves resources with an expected mean savings per patient ranging from €300 to €900.”

He added that further research is being planned to perform the same type of analysis in different countries and to evaluate the long-term cost effectiveness of FFR-guidance out to 5 years.

 

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Source:
Siebert U. Cost-effectiveness and public health/budget impact of FFR-guided PCI in multivessel patients in Europe. Analysis of the FAME study data. Presented at: EuroPCR; May 20, 2011; Paris, France.

 

Disclosures:

• The study was sponsored in part by an independent research grant from St. Jude Medical.

 

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• FAME Published: FFR Guidance Improves Outcomes in Multivessel Disease