Economic Evaluation of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease
Economic Evaluation of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Patients With Multivessel Disease
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DOI：
10.1161/circulationaha.109.925396
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发表时间：
2010-12-14
期刊：
影响因子：
37.8
通讯作者：
Siebert, Uwe
中科院分区：
文献类型：
--
作者：
Fearon, William F.;Bornschein, Bernhard;Siebert, Uwe
背景：血流储备分数与多支血管评价血管造影术(FAME)研究显示，与单纯血管造影引导的经皮冠状动脉介入治疗相比，随机接受血流储备分数(FFR)引导的多支冠状动脉介入治疗的患者1年后的健康状况显著改善。在这种情况下常规测量FFR的经济影响尚不清楚。方法和结果-在这项研究中，1005名患者被随机分配到FFR引导或血管造影引导的经皮冠状动脉介入治疗，并随访1年。进行了一项前瞻性成本效用分析，比较了成本和质量调整的寿命年，时间跨度为1年。通过使用EuroQuol 5维健康调查确定的效用和美国体重计算质量调整后的寿命年。直接医疗费用包括指标程序和住院费用以及随访期间主要不良心脏事件的费用。用Bootstrap百分位数方法估计了质量调整寿命年和费用的可信区间。1年后心脏事件发生率分别为13.2%和18.3%(P=0.02)。在FFR引导的ARM中，质量调整后的寿命年略长(0.853比0.838；P=0.20)。在FFR引导的ARM中，1年的平均总成本显著低于FFR引导的ARM(14315美元对16700美元；P
Background-The Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) study demonstrated significantly improved health outcomes at 1 year in patients randomized to multivessel percutaneous coronary intervention guided by fractional flow reserve (FFR) compared with percutaneous coronary intervention guided by angiography alone. The economic impact of routine measurement of FFR in this setting is not known.Methods and Results-In this study, 1005 patients were randomly assigned to FFR-guided or angiography-guided percutaneous coronary intervention and followed up for 1 year. A prospective cost-utility analysis comparing costs and quality-adjusted life-years was performed with a time horizon of 1 year. Quality-adjusted life-years were calculated with the use of utilities determined by the EuroQuol 5 dimension health survey with US weights. Direct medical costs included those of the index procedure and hospitalization and costs for major adverse cardiac events during follow-up. Confidence intervals for both quality-adjusted life-years and costs were estimated by the bootstrap percentile method. Major adverse cardiac events at 1 year occurred in 13.2% of those in the FFR-guided arm and 18.3% of those in the angiography-guided arm (P=0.02). Quality-adjusted life-years were slightly greater in the FFR-guided arm (0.853 versus 0.838; P=0.2). Mean overall costs at 1 year were significantly less in the FFR-guided arm ($14 315 versus $16 700; P