文章基本信息

标题：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
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作者：Julian Nam ; Andrew Briggs ; Jamie Layland 等
期刊名称：Cost Effectiveness and Resource Allocation
印刷版ISSN：1478-7547
电子版ISSN：1478-7547
出版年度：2015
卷号：13
期号：1
页码：19
DOI：10.1186/s12962-015-0045-9
语种：English
出版社：BioMed Central
摘要：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. 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 %. 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. FFR was cost-effective at the mean, albeit with considerable decision uncertainty. Uncertainty can be reduced with more information on long-term health events.
关键词：Percutaneous Coronary Intervention ; Coronary Artery Bypass Graft ; Fractional Flow Reserve ; Bivalirudin ; Lifetime Horizon