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Fractional flow reserve (FFR) versus angiography in guiding management to optimise outcomes in non-ST segment elevation myocardial infarction (FAMOUS-NSTEMI) developmental trial: cost-effectiveness using a mixed trial- and model-based methods

BACKGROUND: In the Fractional flow reserve (FFR) versus angiography in guiding management to optimise outcomes in non-ST elevation myocardial infarction (FAMOUS) clinical trial, FFR was shown to significantly reduce coronary revascularisation, compared to visual interpretation of standard coronary a...

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Autores principales: Nam, Julian, Briggs, Andrew, Layland, Jamie, Oldroyd, Keith G., Curzen, Nick, Sood, Arvind, Balachandran, Kanarath, Das, Raj, Junejo, Shahid, Eteiba, Hany, Petrie, Mark C., Lindsay, Mitchell, Watkins, Stuart, Corbett, Simon, O’Rourke, Brian, O’Donnell, Anna, Stewart, Andrew, Hannah, Andrew, McConnachie, Alex, Henderson, Robert, Berry, Colin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4647286/
https://www.ncbi.nlm.nih.gov/pubmed/26578850
http://dx.doi.org/10.1186/s12962-015-0045-9
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author Nam, Julian
Briggs, Andrew
Layland, Jamie
Oldroyd, Keith G.
Curzen, Nick
Sood, Arvind
Balachandran, Kanarath
Das, Raj
Junejo, Shahid
Eteiba, Hany
Petrie, Mark C.
Lindsay, Mitchell
Watkins, Stuart
Corbett, Simon
O’Rourke, Brian
O’Donnell, Anna
Stewart, Andrew
Hannah, Andrew
McConnachie, Alex
Henderson, Robert
Berry, Colin
author_facet Nam, Julian
Briggs, Andrew
Layland, Jamie
Oldroyd, Keith G.
Curzen, Nick
Sood, Arvind
Balachandran, Kanarath
Das, Raj
Junejo, Shahid
Eteiba, Hany
Petrie, Mark C.
Lindsay, Mitchell
Watkins, Stuart
Corbett, Simon
O’Rourke, Brian
O’Donnell, Anna
Stewart, Andrew
Hannah, Andrew
McConnachie, Alex
Henderson, Robert
Berry, Colin
author_sort Nam, Julian
collection PubMed
description BACKGROUND: In the Fractional flow reserve (FFR) versus angiography in guiding management to optimise outcomes in non-ST elevation myocardial infarction (FAMOUS) clinical trial, FFR was shown to significantly reduce coronary revascularisation, compared to visual interpretation of standard coronary angiography without FFR. We estimated the cost-effectiveness from a UK National Health Service perspective, based on the results of FAMOUS. METHODS: A mixed trial- and model-based approach using decision and statistical modelling was used. Within-trial (1-year) costs and QALYs were assembled at the individual level and then modelled on subsequent management strategy [coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) or medical therapy (MT)] and major adverse coronary events (death, MI, stroke and revascularisation). One-year resource uses included: material, hospitalisation, medical, health professional service use and events. Utilities were derived from individual EQ5D responses. Unit costs were derived from the literature. Outcomes were extended to a lifetime on the basis of MACE during the 1st year. Costs and QALYs were modelled using generalized linear models whilst MACE was modelled using logistic regression. The analysis adopted a payer perspective. Costs and outcomes were discounted at 3.5 %. RESULTS: Costs were related to the subsequent management strategy and MACE whilst QALYs were not. FFR led to a modest cost increase, albeit an imprecise increase, over both the trial [£112 (−£129 to £357)] and lifetime horizons [£133 (−£199 to £499)]. FFR led to a small, albeit imprecise, increase in QALYs over both the trial [0.02 (−0.03 to 0.06)] and lifetime horizons [0.03 (−0.21 to 0.28)]. The mean ICER was £7516/QALY and £4290/QALY over the trial and lifetime horizons, respectively. Decision remained high; FFR had 64 and 59 % probability of cost-effectiveness over trial and lifetime horizons, respectively. CONCLUSIONS: FFR was cost-effective at the mean, albeit with considerable decision uncertainty. Uncertainty can be reduced with more information on long-term health events. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12962-015-0045-9) contains supplementary material, which is available to authorized users.
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spelling pubmed-46472862015-11-18 Fractional flow reserve (FFR) versus angiography in guiding management to optimise outcomes in non-ST segment elevation myocardial infarction (FAMOUS-NSTEMI) developmental trial: cost-effectiveness using a mixed trial- and model-based methods Nam, Julian Briggs, Andrew Layland, Jamie Oldroyd, Keith G. Curzen, Nick Sood, Arvind Balachandran, Kanarath Das, Raj Junejo, Shahid Eteiba, Hany Petrie, Mark C. Lindsay, Mitchell Watkins, Stuart Corbett, Simon O’Rourke, Brian O’Donnell, Anna Stewart, Andrew Hannah, Andrew McConnachie, Alex Henderson, Robert Berry, Colin Cost Eff Resour Alloc Research BACKGROUND: In the Fractional flow reserve (FFR) versus angiography in guiding management to optimise outcomes in non-ST elevation myocardial infarction (FAMOUS) clinical trial, FFR was shown to significantly reduce coronary revascularisation, compared to visual interpretation of standard coronary angiography without FFR. We estimated the cost-effectiveness from a UK National Health Service perspective, based on the results of FAMOUS. METHODS: A mixed trial- and model-based approach using decision and statistical modelling was used. Within-trial (1-year) costs and QALYs were assembled at the individual level and then modelled on subsequent management strategy [coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI) or medical therapy (MT)] and major adverse coronary events (death, MI, stroke and revascularisation). One-year resource uses included: material, hospitalisation, medical, health professional service use and events. Utilities were derived from individual EQ5D responses. Unit costs were derived from the literature. Outcomes were extended to a lifetime on the basis of MACE during the 1st year. Costs and QALYs were modelled using generalized linear models whilst MACE was modelled using logistic regression. The analysis adopted a payer perspective. Costs and outcomes were discounted at 3.5 %. RESULTS: Costs were related to the subsequent management strategy and MACE whilst QALYs were not. FFR led to a modest cost increase, albeit an imprecise increase, over both the trial [£112 (−£129 to £357)] and lifetime horizons [£133 (−£199 to £499)]. FFR led to a small, albeit imprecise, increase in QALYs over both the trial [0.02 (−0.03 to 0.06)] and lifetime horizons [0.03 (−0.21 to 0.28)]. The mean ICER was £7516/QALY and £4290/QALY over the trial and lifetime horizons, respectively. Decision remained high; FFR had 64 and 59 % probability of cost-effectiveness over trial and lifetime horizons, respectively. CONCLUSIONS: FFR was cost-effective at the mean, albeit with considerable decision uncertainty. Uncertainty can be reduced with more information on long-term health events. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12962-015-0045-9) contains supplementary material, which is available to authorized users. BioMed Central 2015-11-14 /pmc/articles/PMC4647286/ /pubmed/26578850 http://dx.doi.org/10.1186/s12962-015-0045-9 Text en © Nam et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Nam, Julian
Briggs, Andrew
Layland, Jamie
Oldroyd, Keith G.
Curzen, Nick
Sood, Arvind
Balachandran, Kanarath
Das, Raj
Junejo, Shahid
Eteiba, Hany
Petrie, Mark C.
Lindsay, Mitchell
Watkins, Stuart
Corbett, Simon
O’Rourke, Brian
O’Donnell, Anna
Stewart, Andrew
Hannah, Andrew
McConnachie, Alex
Henderson, Robert
Berry, Colin
Fractional flow reserve (FFR) versus angiography in guiding management to optimise outcomes in non-ST segment elevation myocardial infarction (FAMOUS-NSTEMI) developmental trial: cost-effectiveness using a mixed trial- and model-based methods
title Fractional flow reserve (FFR) versus angiography in guiding management to optimise outcomes in non-ST segment elevation myocardial infarction (FAMOUS-NSTEMI) developmental trial: cost-effectiveness using a mixed trial- and model-based methods
title_full Fractional flow reserve (FFR) versus angiography in guiding management to optimise outcomes in non-ST segment elevation myocardial infarction (FAMOUS-NSTEMI) developmental trial: cost-effectiveness using a mixed trial- and model-based methods
title_fullStr Fractional flow reserve (FFR) versus angiography in guiding management to optimise outcomes in non-ST segment elevation myocardial infarction (FAMOUS-NSTEMI) developmental trial: cost-effectiveness using a mixed trial- and model-based methods
title_full_unstemmed Fractional flow reserve (FFR) versus angiography in guiding management to optimise outcomes in non-ST segment elevation myocardial infarction (FAMOUS-NSTEMI) developmental trial: cost-effectiveness using a mixed trial- and model-based methods
title_short Fractional flow reserve (FFR) versus angiography in guiding management to optimise outcomes in non-ST segment elevation myocardial infarction (FAMOUS-NSTEMI) developmental trial: cost-effectiveness using a mixed trial- and model-based methods
title_sort fractional flow reserve (ffr) versus angiography in guiding management to optimise outcomes in non-st segment elevation myocardial infarction (famous-nstemi) developmental trial: cost-effectiveness using a mixed trial- and model-based methods
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4647286/
https://www.ncbi.nlm.nih.gov/pubmed/26578850
http://dx.doi.org/10.1186/s12962-015-0045-9
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