Key result
FFRct after inconclusive CCTA saves costs and avoids ~154 unnecessary ICAs per 1000 patients.
Why the study?
To model and evaluate the cost-effectiveness of CT-based fractional flow reserve (FFRct) in low- to intermediate-risk patients presenting to the emergency department with acute chest pain.
Is FFRct cost-effective for triage of low to intermediate risk patients presenting to the emergency department with acute chest pain?
Is FFRct cost-effective for triage of low to intermediate risk patients presenting to the emergency department with acute chest pain?
Using FFRct selectively when CCTA is inconclusive is a cost-effective strategy that reduces unnecessary invasive angiographies in ED patients with acute chest pain.
May support cost savings and fewer angiographies with selective FFRct after inconclusive CCTA; leaves open randomized confirmation.
AIMS: To model and assess the cost-effectiveness of CT-based fractional flow reserve (FFRct) for a population of low to intermediate risk patients for coronary artery disease (CAD) presenting to the emergency department (ED) with acute chest pain. METHODS AND RESULTS: Using a decision tree model with a 1 year time horizon and from a health care perspective, two diagnostic pathways using FFRct are compared to current clinical routine combining coronary computed tomography angiography (CCTA) with an exercise test. Model data are drawn from the literature and nationally reported data. Outcomes are assessed as the number of avoided invasive coronary angiographies (ICAs) showing no obstructive CAD and quality of life (QoL) in a theoretical cohort of 1000 patients. Sensitivity analyses are performed to test the robustness of the results. Determining FFRct when CCTA is inconclusive is a cost-effective and dominant strategy with a potential saving of 198€/patient, 154 avoided unnecessary ICA showing no obstructive CAD (uICA)/1000 patients and an average improvement in QoL of 0.008 QALY/patient. With an additional 574€/patient, 8 avoided uICA/1000 patients and an improvement in QoL of 0.001 QALY/patient, a strategy where FFRct is always performed is cost-effective only when considering high cost-effectiveness thresholds. CONCLUSIONS: For patients presenting to the ED with acute chest pain and a low to intermediate pre-test probability of CAD, a diagnostic strategy where FFRct is determined after an inconclusive CCTA is cost-effective. Clinical trials investigating both sensitivity and specificity of FFRct, as well as QoL associated with the use of this technology in this setting are warranted.
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Choustoulakis et al. (2023) studied Acute chest pain with low to intermediate risk for coronary artery disease (n=1,000). CT-based fractional flow reserve (FFRct) vs. Coronary computed tomography angiography (CCTA) combined with an exercise test was evaluated on Number of avoided invasive coronary angiographies showing no obstructive CAD and quality of life. Determining FFRct after an inconclusive CCTA for acute chest pain triage is cost-effective, saving 198€ per patient and avoiding 154 unnecessary invasive coronary angiographies per 1000 patients.
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