Introduction: FAME study 2, presented at the European Congress of Cardiology 2012, is a multicenter study that randomized patients with stable angina FFR-guided angioplasty and optimal medical therapy versus optimal medical therapy alone. The study was stopped early due to a significantly higher rate of primary endpoints, (death, MI, or urgent revascularization), in the conservative group. This analysis evaluates the cost-effectiveness of a FFR-guided invasive strategy.
Methods and Results: Direct medical costs of procedure and hospitalization were recorded. Costs were assigned to monitor events, based on the cost of each diagnosis under Medicare. We used a quality of life, (EQ-5D), score for determining the quality-adjusted life year (QALYs). Cost-effectiveness was calculated for the first year and then projected for 3 years follow up. The initial average cost of the invasive group was U.S.$ 8,790 versus U.S.$ 3,305 in the conservative group, at cost of procedure disbursement. At follow-up, the average cost of the invasive group was U.S.$ 2,584 versus U.S.$ 5,561 in the clinical group due to the costs of new percutaneous procedures. In total, the average cost of the invasive group was U.S.$ 11,374 versus U.S.$ 8,866 for the conservative group. At follow-up, there was a reduction of about 50% with respect to the costs between groups. After a month of monitoring, 89% of patients in the invasive group had angina class 0/1 versus 71% in the clinical group (p <0.001). Cost-effectiveness of the invasive group a year guided by FFR was $ 53,000/QALY and projected at three years was $ 32,000/QALY.
Conclusions: FFR-guided angioplasty has an acceptable cost-effectiveness when compared with conservative treatment in patients with stable angina and confirmed ischemia.
William Fearon
2012-10-24
Original title: FAME 2 Cost-effectiveness: A Prospective, Randomized Trial Evaluating the Cost-effectiveness of FFR-Guided PCI in Patients with Stable Coronary Artery Disease
