Elsevier

International Journal of Cardiology

Volume 344, 1 December 2021, Pages 54-59
International Journal of Cardiology

Instantaneous wave-free ratio compared with fractional flow reserve in PCI: A cost-minimization analysis

https://doi.org/10.1016/j.ijcard.2021.09.054Get rights and content
Under a Creative Commons license
open access

Highlights

  • Coronary physiology to guide revascularization improves clinical outcome.

  • Instantaneous wave-free ratio and Fractional flow reserve provide similar clinical outcome.

  • Revascularization guided by Instantaneous wave-free ratio is cost saving compared to Fractional flow reserve.

Abstract

Background

Coronary physiology is a routine diagnostic tool when assessing whether coronary revascularization is indicated. The iFR-SWEDEHEART trial demonstrated similar clinical outcomes when using instantaneous wave-free ratio (iFR) or fractional flow reserve (FFR) to guide revascularization. The objective of this analysis was to assess a cost-minimization analysis of iFR-guided compared with FFR-guided revascularization.

Methods

In this cost-minimization analysis we used a decision-tree model from a healthcare perspective with a time-horizon of one year to estimate the cost difference between iFR and FFR in a Nordic setting and a United States (US) setting. Treatment pathways and health care utilizations were constructed from the iFR-SWEDEHEART trial. Unit cost for revascularization and myocardial infarction in the Nordic setting and US setting were derived from the Nordic diagnosis-related group versus Medicare cost data. Unit cost of intravenous adenosine administration and cost per stent placed were based on the average costs from the enrolled centers in the iFR-SWEDEHEART trial. Deterministic and probabilistic sensitivity analyses were carried out to test the robustness of the result.

Results

The cost-minimization analysis demonstrated a cost saving per patient of $681 (95% CI: $641 - $723) in the Nordic setting and $1024 (95% CI: $934 - $1114) in the US setting, when using iFR-guided compared with FFR-guided revascularization. The results were not sensitive to changes in uncertain parameters or assumptions.

Conclusions

IFR-guided revascularization is associated with significant savings in cost compared with FFR-guided revascularization.

Keywords

Instantaneous wave-free ratio
Fractional flow reserve
Cost-minimization analysis

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1

This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation