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Randomized comparison of chest pain evaluation with FFRCT or standard care: Factors determining US costs

Published:September 24, 2022DOI:https://doi.org/10.1016/j.jcct.2022.09.005

      Abstract

      Background

      FFRCT 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 FFRCT), 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 FFRCT 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).

      Keywords

      Abbreviations:

      CI (95% confidence interval), CTCA (Computed tomography coronary angiography), FFR (Fractional flow reserve), FFRCT (Fractional flow reserve derived from computed tomography coronary angiography), FORECAST (Fractional Flow Reserve Derived from Computed Tomography Coronary Angiography in the Assessment and Management of Stable Chest Pain), PLATFORM (Prospective Longitudinal Trial of FFRCT: Outcomes and Resource Impacts), UK (United Kingdom), US (United States)
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