Fractional flow reserve (FFR) versus angiography in guiding management to optimise outcomes in non-ST segment elevation myocardial infarction (FAMOUS-NSTEMI) developmental trial: cost-effectiveness using a mixed trial- and model-based methods. Issue 1 (December 2015)

• Record Type: Journal Article
• Authors: Nam, Julian; Briggs, Andrew; Layland, Jamie; Oldroyd, Keith; Curzen, Nick; Sood, Arvind; Balachandran, Kanarath; Das, Raj; Junejo, Shahid; Eteiba, Hany; Petrie, Mark; Lindsay, Mitchell; Watkins, Stuart; Corbett, Simon; O'Rourke, Brian; O'Donnell, Anna; Stewart, Andrew; Hannah, Andrew; McConnachie, Alex; Henderson, Robert; Berry, Colin
• Is Part Of: Cost effectiveness and resource allocation. Volume 13:Issue 1(2015)
• Page Start: 1
• Page End: 9
• Publication Date: 2015-12
• Subjects: Medical care -- Cost effectiveness -- Periodicals; Medical economics -- Periodicals; Resource allocation -- Periodicals; Medical care -- Evaluation -- Periodicals; Medical ethics -- Periodicals; Medical care -- Political aspects -- Periodicals; 338.433621
• DOI: 10.1186/s12962-015-0045-9
• Languages: English
• ISSNs: 1478-7547

Abstract

Abstract Background In the Fractional flow reserve (FFR) versus angiography in guiding management to optimise outcomes in non-ST elevation myocardial infarction (FAMOUS) clinical trial, FFR was shown to significantly reduce coronary revascularisation, compared to visual interpretation of standard coronary angiography without FFR. We estimated the cost-effectiveness from a UK National Health Service perspective, based on the results of FAMOUS. Methods A mixed trial- and model-based approach using decision and statistical modelling was used. Within-trial (1-year) costs and QALYs were assembled at the individual level and then modelled on subsequent management strategy [coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) or medical therapy (MT)] and major adverse coronary events (death, MI, stroke and revascularisation). One-year resource uses included: material, hospitalisation, medical, health professional service use and events. Utilities were derived from individual EQ5D responses. Unit costs were derived from the literature. Outcomes were extended to a lifetime on the basis of MACE during the 1st year. Costs and QALYs were modelled using generalized linear models whilst MACE was modelled using logistic regression. The analysis adopted a payer perspective. Costs and outcomes were discounted at 3.5 %. Results Costs were related to the subsequent management strategy and MACE whilst QALYs were not. FFR led to a modest cost increase, albeit an imprecise increase, over both the trial [£112 (−£129 to £357)] and lifetime horizons [£133 (−£199 to £499)]. FFR led to a small, albeit imprecise, increase in QALYs over both the trial [0.02 (−0.03 to 0.06)] and lifetime horizons [0.03 (−0.21 to 0.28)]. The mean ICER was £7516/QALY and £4290/QALY over the trial and lifetime horizons, respectively. Decision remained high; FFR had 64 and 59 % probability of cost-effectiveness over trial and lifetime horizons, respectively. Conclusions FFR was cost-effective at the mean, albeit with considerable decision uncertainty. Uncertainty can be reduced with more information on long-term health events.