Cost analysis of non-invasive fractional flow reserve derived from coronary computed tomographic angiography in Japan

Percutaneous coronary intervention (PCI) based on fractional flow reserve (FFR(cath)) measurement during invasive coronary angiography (CAG) results in improved patient outcome and reduced healthcare costs. FFR can now be computed non-invasively from standard coronary CT angiography (cCTA) scans (FFR(CT)). The purpose of this study is to determine the potential impact of non-invasive FFR(CT) on costs and clinical outcomes of patients with suspected coronary artery disease in Japan. Clinical data from 254 patients in the HeartFlowNXT trial, costs of goods and services in Japan, and clinical outcome data from the literature were used to estimate the costs and outcomes of 4 clinical pathways: (1) CAG-visual guided PCI, (2) CAG-FFR(cath) guided PCI, (3) cCTA followed by CAG-visual guided PCI, (4) cCTA-FFR(CT) guided PCI. The CAG-visual strategy demonstrated the highest projected cost ($10,360) and highest projected 1-year death/myocardial infarction rate (2.4 %). An assumed price for FFR(CT) of US $2,000 produced equivalent clinical outcomes (death/MI rate: 1.9 %) and healthcare costs ($7,222) for the cCTA-FFR(CT) strategy and the CAG-FFR(cath) guided PCI strategy. Use of the cCTA-FFR(CT) strategy to select patients for PCI would result in 32 % lower costs and 19 % fewer cardiac events at 1 year compared to the most commonly used CAG-visual strategy. Use of cCTA-FFR(CT) to select patients for CAG and PCI may reduce costs and improve clinical outcome in patients with suspected coronary artery disease in Japan.