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Quality-of-Life and economic outcomes of assessing fractional flow reserve with computed tomography angiography: PLATFORM

Quality-of-Life and economic outcomes of assessing fractional flow reserve with computed tomography angiography: PLATFORM
Quality-of-Life and economic outcomes of assessing fractional flow reserve with computed tomography angiography: PLATFORM

BACKGROUND: Fractional flow reserve estimated using computed tomography (FFRCT) might improve evaluation of patients with chest pain.

OBJECTIVES: The authors sought to determine the effect on cost and quality of life (QOL) of using FFRCT instead of usual care to evaluate stable patients with symptoms suspicious for coronary disease.

METHODS: Symptomatic patients without known coronary disease were enrolled into 2 strata based on whether invasive or noninvasive diagnostic testing was planned. In each stratum, consecutive observational cohorts were evaluated with either usual care or FFRCT. The number of diagnostic tests, invasive procedures, hospitalizations, and medications during 90-day follow-up were multiplied by U.S. cost weights and summed to derive total medical costs. Changes in QOL from baseline to 90 days were assessed using the Seattle Angina Questionnaire, the EuroQOL, and a visual analog scale.

RESULTS: In the 584 patients, 74% had atypical angina, and the pre-test probability of coronary disease was 49%. In the planned invasive stratum, mean costs were 32% lower among the FFRCT patients than among the usual care patients ($7,343 vs. $10,734 p < 0.0001). In the noninvasive stratum, mean costs were not significantly different between the FFRCT patients and the usual care patients ($2,679 vs. $2,137; p = 0.26). In a sensitivity analysis, when the cost weight of FFRCT was set to 7 times that of computed tomography angiography, the FFRCT group still had lower costs than the usual care group in the invasive testing stratum ($8,619 vs. $ 10,734; p < 0.0001), whereas in the noninvasive testing stratum, when the cost weight of FFRCT was set to one-half that of computed tomography angiography, the FFRCT group had higher costs than the usual care group ($2,766 vs. $2,137; p = 0.02). Each QOL score improved in the overall study population (p < 0.0001). In the noninvasive stratum, QOL scores improved more in FFRCT patients than in usual care patients: Seattle Angina Questionnaire 19.5 versus 11.4, p = 0.003; EuroQOL 0.08 versus 0.03, p = 0.002; and visual analog scale 4.1 versus 2.3, p = 0.82. In the invasive cohort, the improvements in QOL were similar in the FFRCT and usual care patients.

CONCLUSIONS: An evaluation strategy based on FFRCT was associated with less resource use and lower costs within 90 days than evaluation with invasive coronary angiography. Evaluation with FFRCT was associated with greater improvement in quality of life than evaluation with usual noninvasive testing. (Prospective Longitudinal Trial of FFRCT: Outcomes and Resource Impacts [PLATFORM]; NCT01943903).

Cohort Studies, Coronary Angiography/economics, Coronary Artery Disease/diagnostic imaging, Female, Fractional Flow Reserve, Myocardial/physiology, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Quality of Life, Tomography, X-Ray Computed/economics, Treatment Outcome
0735-1097
2315-2323
Hlatky, Mark A
43f00437-a3e4-4f81-aed9-5b0ca52cd86e
De Bruyne, Bernard
6c86ad29-d853-4e59-9633-f536a17efd4e
Pontone, Gianluca
a38cc1ea-5dba-4a34-80e9-478556029dad
Patel, Manesh R
d4bc16f4-6708-401e-8301-6ab5fe9bb8b7
Norgaard, Bjarne L
5bd2107d-613f-4cff-a1f7-ca08b22c04eb
Byrne, Robert A
85863b99-534c-4bfd-8a36-3cdb796c0882
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Purcell, Ian
d38e7a5f-fe49-4599-a47f-cca3b8d593dd
Gutberlet, Matthias
e77cfb43-d42e-46b1-8fa3-eae2ca72d609
Rioufol, Gilles
87163c97-9ed4-477a-9692-6ac8506fcd9f
Hink, Ulrich
eedfda99-4266-4c6a-97c0-a05c0e6e9835
Schuchlenz, Herwig Walter
523fa731-6c32-41e6-a944-f7d715816f42
Feuchtner, Gudrun
32f34428-460b-4cbf-80e8-ffdd50d340a3
Gilard, Martine
feae684c-07b6-4e93-8fd8-234d0941c82d
Andreini, Daniele
e8194b12-290b-47f8-a274-abf0945f2480
Jensen, Jesper M
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Hadamitzky, Martin
4f6b7e2d-e7d2-4ec7-81b3-43de27ebf118
Wilk, Alan
ea4fa3ae-1396-45f3-a371-bcfdc8dfb88b
Wang, Furong
08648899-449a-4243-a58b-6aa3186b4926
Rogers, Campbell
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Douglas, Pamela S
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PLATFORM Investigators
Hlatky, Mark A
43f00437-a3e4-4f81-aed9-5b0ca52cd86e
De Bruyne, Bernard
6c86ad29-d853-4e59-9633-f536a17efd4e
Pontone, Gianluca
a38cc1ea-5dba-4a34-80e9-478556029dad
Patel, Manesh R
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Norgaard, Bjarne L
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Byrne, Robert A
85863b99-534c-4bfd-8a36-3cdb796c0882
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Purcell, Ian
d38e7a5f-fe49-4599-a47f-cca3b8d593dd
Gutberlet, Matthias
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Rioufol, Gilles
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Hink, Ulrich
eedfda99-4266-4c6a-97c0-a05c0e6e9835
Schuchlenz, Herwig Walter
523fa731-6c32-41e6-a944-f7d715816f42
Feuchtner, Gudrun
32f34428-460b-4cbf-80e8-ffdd50d340a3
Gilard, Martine
feae684c-07b6-4e93-8fd8-234d0941c82d
Andreini, Daniele
e8194b12-290b-47f8-a274-abf0945f2480
Jensen, Jesper M
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Hadamitzky, Martin
4f6b7e2d-e7d2-4ec7-81b3-43de27ebf118
Wilk, Alan
ea4fa3ae-1396-45f3-a371-bcfdc8dfb88b
Wang, Furong
08648899-449a-4243-a58b-6aa3186b4926
Rogers, Campbell
30ecce2e-9a3e-4e7f-9280-8511a5865eda
Douglas, Pamela S
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Hlatky, Mark A, De Bruyne, Bernard, Pontone, Gianluca, Patel, Manesh R, Norgaard, Bjarne L, Byrne, Robert A, Curzen, Nick, Purcell, Ian, Gutberlet, Matthias, Rioufol, Gilles, Hink, Ulrich, Schuchlenz, Herwig Walter, Feuchtner, Gudrun, Gilard, Martine, Andreini, Daniele, Jensen, Jesper M, Hadamitzky, Martin, Wilk, Alan, Wang, Furong, Rogers, Campbell and Douglas, Pamela S , PLATFORM Investigators (2015) Quality-of-Life and economic outcomes of assessing fractional flow reserve with computed tomography angiography: PLATFORM. Journal of the American College of Cardiology, 66 (21), 2315-2323. (doi:10.1016/j.jacc.2015.09.051).

Record type: Article

Abstract

BACKGROUND: Fractional flow reserve estimated using computed tomography (FFRCT) might improve evaluation of patients with chest pain.

OBJECTIVES: The authors sought to determine the effect on cost and quality of life (QOL) of using FFRCT instead of usual care to evaluate stable patients with symptoms suspicious for coronary disease.

METHODS: Symptomatic patients without known coronary disease were enrolled into 2 strata based on whether invasive or noninvasive diagnostic testing was planned. In each stratum, consecutive observational cohorts were evaluated with either usual care or FFRCT. The number of diagnostic tests, invasive procedures, hospitalizations, and medications during 90-day follow-up were multiplied by U.S. cost weights and summed to derive total medical costs. Changes in QOL from baseline to 90 days were assessed using the Seattle Angina Questionnaire, the EuroQOL, and a visual analog scale.

RESULTS: In the 584 patients, 74% had atypical angina, and the pre-test probability of coronary disease was 49%. In the planned invasive stratum, mean costs were 32% lower among the FFRCT patients than among the usual care patients ($7,343 vs. $10,734 p < 0.0001). In the noninvasive stratum, mean costs were not significantly different between the FFRCT patients and the usual care patients ($2,679 vs. $2,137; p = 0.26). In a sensitivity analysis, when the cost weight of FFRCT was set to 7 times that of computed tomography angiography, the FFRCT group still had lower costs than the usual care group in the invasive testing stratum ($8,619 vs. $ 10,734; p < 0.0001), whereas in the noninvasive testing stratum, when the cost weight of FFRCT was set to one-half that of computed tomography angiography, the FFRCT group had higher costs than the usual care group ($2,766 vs. $2,137; p = 0.02). Each QOL score improved in the overall study population (p < 0.0001). In the noninvasive stratum, QOL scores improved more in FFRCT patients than in usual care patients: Seattle Angina Questionnaire 19.5 versus 11.4, p = 0.003; EuroQOL 0.08 versus 0.03, p = 0.002; and visual analog scale 4.1 versus 2.3, p = 0.82. In the invasive cohort, the improvements in QOL were similar in the FFRCT and usual care patients.

CONCLUSIONS: An evaluation strategy based on FFRCT was associated with less resource use and lower costs within 90 days than evaluation with invasive coronary angiography. Evaluation with FFRCT was associated with greater improvement in quality of life than evaluation with usual noninvasive testing. (Prospective Longitudinal Trial of FFRCT: Outcomes and Resource Impacts [PLATFORM]; NCT01943903).

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More information

Accepted/In Press date: 25 September 2015
e-pub ahead of print date: 14 October 2015
Published date: 1 December 2015
Keywords: Cohort Studies, Coronary Angiography/economics, Coronary Artery Disease/diagnostic imaging, Female, Fractional Flow Reserve, Myocardial/physiology, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Quality of Life, Tomography, X-Ray Computed/economics, Treatment Outcome

Identifiers

Local EPrints ID: 435976
URI: http://eprints.soton.ac.uk/id/eprint/435976
ISSN: 0735-1097
PURE UUID: 1c704643-415a-4cb8-a73f-28339930f3aa
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 25 Nov 2019 17:30
Last modified: 28 Apr 2022 01:55

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Contributors

Author: Mark A Hlatky
Author: Bernard De Bruyne
Author: Gianluca Pontone
Author: Manesh R Patel
Author: Bjarne L Norgaard
Author: Robert A Byrne
Author: Nick Curzen ORCID iD
Author: Ian Purcell
Author: Matthias Gutberlet
Author: Gilles Rioufol
Author: Ulrich Hink
Author: Herwig Walter Schuchlenz
Author: Gudrun Feuchtner
Author: Martine Gilard
Author: Daniele Andreini
Author: Jesper M Jensen
Author: Martin Hadamitzky
Author: Alan Wilk
Author: Furong Wang
Author: Campbell Rogers
Author: Pamela S Douglas
Corporate Author: PLATFORM Investigators

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