Randomized comparison of chest pain evaluation with FFRCT or standard care: Factors determining US costs
Randomized comparison of chest pain evaluation with FFRCT or standard care: Factors determining US costs
Background: FFR CT assesses the functional significance of lesions seen on CTCA, and may be a more efficient approach to chest pain evaluation. The FORECAST randomized trial found no significant difference in costs within the UK National Health Service, but implications for US costs are unknown. The purpose of this study was to compare costs in the FORECAST trial based on US healthcare cost weights, and to evaluate factors affecting costs.
Methods: patients with stable chest pain were randomized either to the experimental strategy (CTCA with selective FFR CT), or to standard clinical pathways. Pre-randomization, the treating clinician declared the planned initial test. The primary outcome was nine-month cardiovascular care costs.
Results: planned initial tests were CTCA in 912 patients (65%), stress testing in 393 (28%), and invasive angiography in 94 (7%). Mean US costs did not differ overall between the experimental strategy and standard care (cost difference +7% (+$324), CI −12% to +26%, p = 0.49). Costs were 4% lower with the experimental strategy in the planned invasive angiography stratum (p for interaction = 0.66). Baseline factors independently associated with costs were older age (+43%), male sex (+55%), diabetes (+37%), hypertension (+61%), hyperlipidemia (+94%), prior angina (+24%), and planned invasive angiography (+160%). Post-randomization cost drivers were coronary revascularization (+348%), invasive angiography (267%), and number of tests (+35%).
Conclusions: initial evaluation of chest pain using CTCA with FFR CT had similar US costs as standard care pathways. Costs were increased by baseline coronary risk factors and planned invasive angiography, and post-randomization invasive procedures and the number of tests. Registration at ClinicalTrials.gov (NCT03187639).
Coronary CT angiography, Health care costs, Myocardial fractional flow reserve, Randomized controlled trial
Hlatky, Mark A.
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Wilding, Sam
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Stuart, Beth
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Nicholas, Zoe
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Shambrook, James
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Eminton, Zina
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Fox, Kim
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Connolly, Derek
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O'kane, Peter
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Hobson, Alex
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Chauhan, Anoop
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Uren, Neal
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Mccann, Gerry P.
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Berry, Colin
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Carter, Justin
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Roobottom, Carl
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Mamas, Mamas
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Rajani, Ronak
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Ford, Ian
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Douglas, Pamela S.
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Curzen, Nick
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24 September 2022
Hlatky, Mark A.
43f00437-a3e4-4f81-aed9-5b0ca52cd86e
Wilding, Sam
a026cae1-cc72-49b5-a52b-ec1d931d72e1
Stuart, Beth
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Nicholas, Zoe
98403583-c418-45ad-836b-1831517dcc5f
Shambrook, James
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Eminton, Zina
44904d98-97be-4080-9a84-bf5742525f8e
Fox, Kim
7e63ca09-a296-42fc-8075-9918c480edce
Connolly, Derek
b361ae83-f87b-4305-96c8-523bb832c191
O'kane, Peter
554315f3-251e-4e9d-8163-1ef54c1076a9
Hobson, Alex
d0f3c2fb-80d2-4154-9d91-9f93ea3205eb
Chauhan, Anoop
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Uren, Neal
5d49a690-9157-4e91-825b-1bf44f4f866e
Mccann, Gerry P.
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Berry, Colin
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Carter, Justin
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Roobottom, Carl
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Mamas, Mamas
41515b72-75ff-4922-bb9f-8f9c63f9f5af
Rajani, Ronak
d5ebf00d-fbdb-47a2-8f17-89b47fb78daf
Ford, Ian
9fd64fa3-4f53-4b12-9536-4506f9759585
Douglas, Pamela S.
b282b64d-d5f2-4cc3-b832-9b8d52009e0c
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Hlatky, Mark A., Wilding, Sam, Stuart, Beth, Nicholas, Zoe, Shambrook, James, Eminton, Zina, Fox, Kim, Connolly, Derek, O'kane, Peter, Hobson, Alex, Chauhan, Anoop, Uren, Neal, Mccann, Gerry P., Berry, Colin, Carter, Justin, Roobottom, Carl, Mamas, Mamas, Rajani, Ronak, Ford, Ian, Douglas, Pamela S. and Curzen, Nick
(2022)
Randomized comparison of chest pain evaluation with FFRCT or standard care: Factors determining US costs.
Journal of Cardiovascular Computed Tomography.
(doi:10.1016/j.jcct.2022.09.005).
Abstract
Background: FFR CT assesses the functional significance of lesions seen on CTCA, and may be a more efficient approach to chest pain evaluation. The FORECAST randomized trial found no significant difference in costs within the UK National Health Service, but implications for US costs are unknown. The purpose of this study was to compare costs in the FORECAST trial based on US healthcare cost weights, and to evaluate factors affecting costs.
Methods: patients with stable chest pain were randomized either to the experimental strategy (CTCA with selective FFR CT), or to standard clinical pathways. Pre-randomization, the treating clinician declared the planned initial test. The primary outcome was nine-month cardiovascular care costs.
Results: planned initial tests were CTCA in 912 patients (65%), stress testing in 393 (28%), and invasive angiography in 94 (7%). Mean US costs did not differ overall between the experimental strategy and standard care (cost difference +7% (+$324), CI −12% to +26%, p = 0.49). Costs were 4% lower with the experimental strategy in the planned invasive angiography stratum (p for interaction = 0.66). Baseline factors independently associated with costs were older age (+43%), male sex (+55%), diabetes (+37%), hypertension (+61%), hyperlipidemia (+94%), prior angina (+24%), and planned invasive angiography (+160%). Post-randomization cost drivers were coronary revascularization (+348%), invasive angiography (267%), and number of tests (+35%).
Conclusions: initial evaluation of chest pain using CTCA with FFR CT had similar US costs as standard care pathways. Costs were increased by baseline coronary risk factors and planned invasive angiography, and post-randomization invasive procedures and the number of tests. Registration at ClinicalTrials.gov (NCT03187639).
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Accepted/In Press date: 21 September 2022
e-pub ahead of print date: 24 September 2022
Published date: 24 September 2022
Additional Information:
Funding Information:
CB is employed by the University of Glasgow, which holds consultancy and research agreements for his work with Abbott Vascular, AstraZeneca, Boehringer Ingelheim, Causeway Therapeutics, Coroventis, Genentech, GSK, HeartFlow, Menarini, Neovasc, Siemens Healthcare, and Valo Health. CB receives research funding from the British Heart Foundation (RE/18/6134217).
Funding Information:
MAH reports a research grant for FORECAST from HeartFLow.
Funding Information:
Supported by research grants from HeartFlow, Inc.
Funding Information:
Supported by research grants from HeartFlow, Inc .
Funding Information:
GM reports grants from HeartFlow & Bayer, and support by a NIHR Research Professorship (2017-08-ST2-007).
Publisher Copyright:
© 2022 Society of Cardiovascular Computed Tomography
Keywords:
Coronary CT angiography, Health care costs, Myocardial fractional flow reserve, Randomized controlled trial
Identifiers
Local EPrints ID: 472796
URI: http://eprints.soton.ac.uk/id/eprint/472796
ISSN: 1934-5925
PURE UUID: bffb5232-fdbe-450f-98dd-f9db751c6a58
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Date deposited: 19 Dec 2022 17:39
Last modified: 17 Mar 2024 03:48
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Contributors
Author:
Mark A. Hlatky
Author:
Zoe Nicholas
Author:
James Shambrook
Author:
Zina Eminton
Author:
Kim Fox
Author:
Derek Connolly
Author:
Peter O'kane
Author:
Alex Hobson
Author:
Anoop Chauhan
Author:
Neal Uren
Author:
Gerry P. Mccann
Author:
Colin Berry
Author:
Justin Carter
Author:
Carl Roobottom
Author:
Mamas Mamas
Author:
Ronak Rajani
Author:
Ian Ford
Author:
Pamela S. Douglas
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