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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

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
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 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.

1478-7547
Nam, Julian
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Briggs, Andrew
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Layland, Jamie
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Oldroyd, Keith G
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Curzen, Nick
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Sood, Arvind
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Balachandran, Kanarath
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Das, Raj
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Junejo, Shahid
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Eteiba, Hany
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Petrie, Mark C
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Lindsay, Mitchell
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Watkins, Stuart
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Corbett, Simon
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O'Rourke, Brian
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O'Donnell, Anna
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Stewart, Andrew
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Hannah, Andrew
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McConnachie, Alex
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Henderson, Robert
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Berry, Colin
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Nam, Julian
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Briggs, Andrew
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Layland, Jamie
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Oldroyd, Keith G
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Curzen, Nick
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Sood, Arvind
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Balachandran, Kanarath
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Das, Raj
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Junejo, Shahid
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Eteiba, Hany
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Petrie, Mark C
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Lindsay, Mitchell
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Watkins, Stuart
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Corbett, Simon
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O'Rourke, Brian
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O'Donnell, Anna
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Stewart, Andrew
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Hannah, Andrew
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McConnachie, Alex
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Henderson, Robert
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Berry, Colin
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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 and Berry, Colin (2015) 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. Cost Effectiveness and Resource Allocation, 13, [19]. (doi:10.1186/s12962-015-0045-9).

Record type: Article

Abstract

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.

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More information

Accepted/In Press date: 31 October 2015
Published date: 14 November 2015

Identifiers

Local EPrints ID: 435688
URI: http://eprints.soton.ac.uk/id/eprint/435688
ISSN: 1478-7547
PURE UUID: 65467a85-e1a9-4e31-9f95-07c86a8f06ca
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 18 Nov 2019 17:30
Last modified: 11 Mar 2022 02:40

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Contributors

Author: Julian Nam
Author: Andrew Briggs
Author: Jamie Layland
Author: Keith G Oldroyd
Author: Nick Curzen ORCID iD
Author: Arvind Sood
Author: Kanarath Balachandran
Author: Raj Das
Author: Shahid Junejo
Author: Hany Eteiba
Author: Mark C Petrie
Author: Mitchell Lindsay
Author: Stuart Watkins
Author: Simon Corbett
Author: Brian O'Rourke
Author: Anna O'Donnell
Author: Andrew Stewart
Author: Andrew Hannah
Author: Alex McConnachie
Author: Robert Henderson
Author: Colin Berry

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