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

Berntorp, Karolina LU orcid ; Persson, Josefine ; Koul, Sasha M. LU ; Patel, Manesh R. ; Christiansen, Evald H. ; Gudmundsdottir, Ingibjörg ; Yndigegn, Troels LU ; Omerovic, Elmir ; Erlinge, David LU orcid and Fröbert, Ole , et al. (2021) In International Journal of Cardiology 344. p.54-59
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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cost-minimization analysis, Fractional flow reserve, Instantaneous wave-free ratio
in
International Journal of Cardiology
volume
344
pages
54 - 59
publisher
Elsevier
external identifiers
  • pmid:34600977
  • scopus:85116405847
ISSN
0167-5273
DOI
10.1016/j.ijcard.2021.09.054
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2021 The Author(s)
id
631070a7-08f9-413e-acec-375226b97981
date added to LUP
2021-10-25 14:48:21
date last changed
2025-04-04 14:13:32
@article{631070a7-08f9-413e-acec-375226b97981,
  abstract     = {{<p>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.</p>}},
  author       = {{Berntorp, Karolina and Persson, Josefine and Koul, Sasha M. and Patel, Manesh R. and Christiansen, Evald H. and Gudmundsdottir, Ingibjörg and Yndigegn, Troels and Omerovic, Elmir and Erlinge, David and Fröbert, Ole and Götberg, Matthias}},
  issn         = {{0167-5273}},
  keywords     = {{Cost-minimization analysis; Fractional flow reserve; Instantaneous wave-free ratio}},
  language     = {{eng}},
  pages        = {{54--59}},
  publisher    = {{Elsevier}},
  series       = {{International Journal of Cardiology}},
  title        = {{Instantaneous wave-free ratio compared with fractional flow reserve in PCI : A cost-minimization analysis}},
  url          = {{http://dx.doi.org/10.1016/j.ijcard.2021.09.054}},
  doi          = {{10.1016/j.ijcard.2021.09.054}},
  volume       = {{344}},
  year         = {{2021}},
}