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Instantaneous wave-free ratio compared with fractional flow reserve in PCI : A cost-minimization analysis

Instantaneous wave-free ratio compared with fractional flow reserve in PCI : A cost-minimization analysis


Title: Instantaneous wave-free ratio compared with fractional flow reserve in PCI : A cost-minimization analysis
Author: Berntorp, Karolina
Persson, Josefine
Koul, Sasha M.
Patel, Manesh R.
Christiansen, Evald H.
Guðmundsdóttir, Ingibjörg Jóna
Yndigegn, Troels
Omerovic, Elmir
Erlinge, David
Fröbert, Ole
... 2 more authors Show all authors
Date: 2021-12-01
Language: English
Scope: 6
University/Institute: Landspitali - The National University Hospital of Iceland
Department: Faculty of Medicine
Cardio-Vascular Center
Series: International Journal of Cardiology; 344()
ISSN: 0167-5273
DOI: https://doi.org/10.1016/j.ijcard.2021.09.054
Subject: Kostnaðargreining; Kransæðasjúkdómar; Lífeðlisfræði; Cost-minimization analysis; Fractional flow reserve; Instantaneous wave-free ratio; Percutaneous Coronary Intervention; Costs and Cost Analysis; Cost-minimization analysis; Fractional flow reserve; Instantaneous wave-free ratio; Percutaneous Coronary Intervention; Costs and Cost Analysis; Cardiology and Cardiovascular Medicine
URI: https://hdl.handle.net/20.500.11815/2857

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Citation:

Berntorp , K , Persson , J , Koul , S M , Patel , M R , Christiansen , E H , Guðmundsdóttir , I J , Yndigegn , T , Omerovic , E , Erlinge , D , Fröbert , O , Götberg , M & Gudmundsdottir , I 2021 , ' Instantaneous wave-free ratio compared with fractional flow reserve in PCI : A cost-minimization analysis ' , International Journal of Cardiology , vol. 344 , pp. 54-59 . https://doi.org/10.1016/j.ijcard.2021.09.054

Abstract:

Background: Coronary physiology is a routine diagnostic tool when assessing whether coronary revascularization is indicated. The iFR-SWEDEHEART trial demonstrated similar clinical outcomes when using instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) to guide revascularization. The objective of this analysis was to assess a cost-minimization analysis of iFR-guided compared with FFR-guided revascularization. Methods: In this cost-minimization analysis we used a decision-tree model from a healthcare perspective with a time-horizon of one year to estimate the cost difference between iFR and FFR in a Nordic setting and a United States (US) setting. Treatment pathways and health care utilizations were constructed from the iFR-SWEDEHEART trial. Unit cost for revascularization and myocardial infarction in the Nordic setting and US setting were derived from the Nordic diagnosis-related group versus Medicare cost data. Unit cost of intravenous adenosine administration and cost per stent placed were based on the average costs from the enrolled centers in the iFR-SWEDEHEART trial. Deterministic and probabilistic sensitivity analyses were carried out to test the robustness of the result. Results: The cost-minimization analysis demonstrated a cost saving per patient of $681 (95% CI: $641 - $723) in the Nordic setting and $1024 (95% CI: $934 - $1114) in the US setting, when using iFR-guided compared with FFR-guided revascularization. The results were not sensitive to changes in uncertain parameters or assumptions. Conclusions: IFR-guided revascularization is associated with significant savings in cost compared with FFR-guided revascularization.

Description:

Acknowledgement of grant support The study was funded by an unrestricted research grant from Philips Volcano, which had no role in the design of the trial or the collection, analysis, or reporting of the data. Declaration of Competing Interest Dr. Götberg reports receiving lecture fees from Volcano, consulting fees and lecture fees from Boston Scientific, and fees for serving on an advisory board from Medtronic; and Dr. Omerovic, receiving grant support and fees for serving on an advisory board from AstraZeneca and grant support from Abbott. No other potential conflict of interest relevant to this article was reported. Publisher Copyright: © 2021 The Author(s)

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