Abstract 1063: Economic Evaluation of the Fractional Flow Reserve vs. Angiography for Multivessel Evaluation (FAME) Study
Background: The Fractional Flow Reserve vs. Angiography for Multivessel Evaluation (FAME) Study demonstrated significantly improved outcomes at 1 year in patients randomized to multivessel percutaneous coronary intervention (PCI) with drug-eluting stents (DES) guided by FFR compared to those patients guided by angiography alone. The economic impact of routine measurement of FFR in this setting is not known.
Methods: In the FAME study, 1005 patients were randomly assigned to FFR-guided PCI or angiography-guided PCI with DES and followed for one year. A cost utility analysis comparing costs vs. quality adjusted life years (QALY) was performed with a time horizon of 12 months. QALYs were calculated using utilities determined by the EQ-5D with US weights. Direct medical costs in US$ included those of the index procedure and hospitalization, as well as those for major adverse cardiac events (MACE) during follow-up. Initial procedure costs were calculated from actual resource consumption; costs for MACE were estimated from the literature. Confidence intervals for both QALYs and costs were estimated by the bootstrap percentile method (1,000 replications).
Results: The primary endpoint of the FAME study, MACE at 1 year, occurred in 13.2% of those in the FFR-guided arm and 18.3% of those in the angio-guided arm (p=0.02). QALYs were significantly greater in the FFR-guided arm (0.882 vs 0.850, for a difference of 0.032, 95%CI 0.010 – 0.056, p<0.05). One year costs were significantly less in the FFR-guided arm ($12,291 vs. $14,357, for a difference of $2,066, 95%CI $1,132-$3,049, p<0.05). Bootstrap simulation indicated that the FFR-guided strategy was cost-saving in 99.8%, and cost-effective in all 1,000 samples.
Conclusion: Economic evaluation of the FAME study reveals that an FFR-guided strategy to PCI in patients with multivessel disease is one of those rare situations in medicine in which a new technology not only improves outcomes, but also saves resources.