Cost-effective Analysis of the Fractional Flow Reserve in an Iranian Cohort With Multivessel Coronary Artery Disease

Abstract

<strong><em>Background:</em></strong> The fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) has proven effective in decreasing cardiac events by comparison with all-comers stenting. In this study, we aimed to evaluate the cost-effectiveness of this method in an Iranian population.<br /> <br /> <strong><em>Methods:</em></strong> In this prospective cohort, patients with moderate stenosis (50%–70% severity) were included, while those with acute coronary syndrome were excluded. The patients were divided into 2 groups: the FFR group, for whom revascularization was performed based on FFR results, and the control group, for whom revascularization was performed based on the interventionist's assessment. An FFR of less than 0.80 was considered ischemic in this investigation.<br /> <br /> <strong><em>Results:</em></strong> A total of 188 patients with moderate coronary artery lesions scheduled for elective PCI were included: 98 patients were assigned to the FFR group and 90 to the control group. Readmission and major adverse cardiac events (MACE) were decreased significantly in the FFR group (24.4% vs 11.2%; <em>P</em> = 0.017 and 25.6% vs 12.2%; <em>P </em>= 0.019, respectively). The quality-adjusted life-year (QALY) value was improved in the FFR group in comparison with the control group (0.8643 ± 0.0961 vs 0.7449 ± 0.10139, respectively; <em>P </em>< 0.001), resulting in a lower cost for each QALY in the FFR group than in the control group (131 395 349 QALY/rials vs 210 666 667 QALY/rials, respectively; <em>P</em> < 0.001). Additionally, our calculation of the incremental cost-effectiveness ratio showed that the cost-effectiveness of the FFR utilization was at least 409 million rials and at most 431 million rials for each QALY, depending on the inclusion of the cost of the FFR catheter.<br /> <br /> <strong><em>Conclusions:</em></strong> Our results demonstrated the effectiveness of FFR in diminishing MACE. The method was cost-effective according to various calculation methods in an Iranian population. <strong><em>(Iranian Heart Journal 2020; 21(3): 64-72)</em></strong>