BACKGROUND

Recent real-world studies have shown fractional flow reserve (FFR) guidance of coronary revascularization therapy to be associated with significantly lower mortality as compared with angiographic guidance alone. However, the costs associated with these clinical advantages remain widely unknown. This analysis evaluated real-world cost implications of FFR from a German payer’s perspective.

METHODS AND RESULTS

The FLORIDA (Fractional FLOw Reserve In cardiovascular DiseAses) study was conducted based on the InGef database, an anonymized claims dataset of more than 4 million German people. Out of 64,045 patients undergoing coronary angiography for suspected coronary artery disease (CAD), 1,992 (3.11%) patients underwent functional lesion assessment with FFR. Using a matched cohort study design, health economic data of the FLORIDA-study cohort (n=3,962) were analyzed comparing total health care costs over 3 years, consisting of index hospital stay as well as follow up costs.

Mean total costs per patient after three years including index hospital stay were 23,903 + 17,346€ for FFR use and 24,491 + 19,660€ for angiography-alone, favoring FFR. Similar costs were also observed in the index hospital stay (FFR: 4,000 + 3,093€, angiography-alone: 4,420 + 6,639€) and the 3-year follow-up period (FFR: 19,904 + 17,068€ vs. 20,071 + 18,506€ for angiography-alone), as well as for every year of follow-up. The highest observable cost difference in favor of FFR was seen after year 1. Index and three-year costs between both arms were comparable among the prespecified study´ subgroups of patients with chronic (CCS) as well as acute coronary syndromes (ACS) and aged-patients (≥75 years). Importantly, this cost-neutral effect was independent of the treatment strategy (revascularization vs. optimal medical therapy) intended after FFR.

CONCLUSIONS

This analysis within the FLORIDA study allows, for the first time, detailed health economic analyses for the use of FFR to guide therapy in a large unselected all-comer study cohort. Its results suggest that, even in a country with established FFR reimbursement, the use of FFR to guide revascularization therapy is cost-neutral in both the short- and long term as compared with angiography-guided therapy.