Economic evaluation of fractional flow reserve-guided versus angiography-guided multivessel revascularisation in ST-segment elevation myocardial infarction patients in the FLOWER-MI randomised trial - Aix-Marseille Université Accéder directement au contenu
Article Dans Une Revue EuroIntervention Année : 2022

Economic evaluation of fractional flow reserve-guided versus angiography-guided multivessel revascularisation in ST-segment elevation myocardial infarction patients in the FLOWER-MI randomised trial

Alicia Le Bras
  • Fonction : Auteur
Etienne Puymirat
  • Fonction : Auteur
Hasina Rabetrano
  • Fonction : Auteur
Guillaume Cayla
  • Fonction : Auteur
Tabassome Simon
  • Fonction : Auteur
Gabriel Steg
  • Fonction : Auteur
Gilles Montalescot
  • Fonction : Auteur
Olivier Varenne
  • Fonction : Auteur
Pierre Coste
  • Fonction : Auteur
Nicolas Delarche
  • Fonction : Auteur
Jean-Louis Georges
  • Fonction : Auteur
Stephan Chassaing
  • Fonction : Auteur
Vincent Letocart
  • Fonction : Auteur
Gilles Chatellier
  • Fonction : Auteur
Nicolas Danchin
  • Fonction : Auteur
Isabelle Durand-Zaleski
  • Fonction : Auteur

Résumé

Background: In patients with ST-segment elevation myocardial infarction (STEMI) who have multivessel disease, the FLOWER-MI trial found no significant clinical benefit to fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared to angiography-guided PCI. Aims: Our aim was to estimate the cost-effectiveness and cost-utility of FFR-guided PCI, the secondary endpoint of the FLOWER-MI trial. Methods: Costs, major adverse cardiovascular events (composite of all-cause death, non-fatal myocardial infarction [MI], and unplanned hospitalisation leading to urgent revascularisation), and quality-adjusted life years were calculated in both groups. The incremental cost-effectiveness and cost-utility ratios were estimated. Uncertainty was explored by probabilistic bootstrapping. The analysis was conducted from the perspective of the health care provider with a time horizon of one year. Results: At one year, the average cost per patient was 7,560 euro (+/- 2,218) in the FFR-guided group and 7,089 euro (+/- 1,991) in the angiography-guided group (p-value<0.01). The point estimates for the incremental cost-effectiveness and cost-utility ratios found that the angiography-guided strategy was cost saving and improved outcomes, with a probabilistic sensitivity analysis confirming dominance. Conclusions: The FFR-guided strategy at one year is unlikely to be cost effective compared to the angiography-guided strategy on both clinical and quality of life outcomes.
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Dates et versions

hal-03800922 , version 1 (06-10-2022)

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Alicia Le Bras, Etienne Puymirat, Hasina Rabetrano, Guillaume Cayla, Tabassome Simon, et al.. Economic evaluation of fractional flow reserve-guided versus angiography-guided multivessel revascularisation in ST-segment elevation myocardial infarction patients in the FLOWER-MI randomised trial. EuroIntervention , 2022, 18 (3), pp.235-241. ⟨10.4244/EIJ-D-21-00867⟩. ⟨hal-03800922⟩
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