Cost-effectiveness of Fractional Flow Reserve Versus Intravascular Ultrasound to Guide Percutaneous Coronary Intervention: Results From the FLAVOUR Study
- Author:
Doyeon HWANG
1
;
Hea-Lim KIM
;
Jane KO
;
HyunJin CHOI
;
Hanna JEONG
;
Sun-ae JANG
;
Xinyang HU
;
Jeehoon KANG
;
Jinlong ZHANG
;
Jun JIANG
;
Joo-Yong HAHN
;
Chang-Wook NAM
;
Joon-Hyung DOH
;
Bong-Ki LEE
;
Weon KIM
;
Jinyu HUANG
;
Fan JIANG
;
Hao ZHOU
;
Peng CHEN
;
Lijiang TANG
;
Wenbing JIANG
;
Xiaomin CHEN
;
Wenming HE
;
Sung Gyun AHN
;
Ung KIM
;
You-Jeong KI
;
Eun-Seok SHIN
;
Hyo-Soo KIM
;
Seung-Jea TAHK
;
JianAn WANG
;
Tae-Jin LEE
;
Bon-Kwon KOO
;
Author Information
- Publication Type:Original Research
- From:Korean Circulation Journal 2025;55(1):34-46
- CountryRepublic of Korea
- Language:English
-
Abstract:
Background and Objectives:The Fractional Flow Reserve and Intravascular UltrasoundGuided Intervention Strategy for Clinical Outcomes in Patients with Intermediate Stenosis (FLAVOUR) trial demonstrated non-inferiority of fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) compared with intravascular ultrasound (IVUS)-guided PCI. We sought to investigate the cost-effectiveness of FFR-guided PCI compared to IVUS-guided PCI in Korea.
Methods:A 2-part cost-effectiveness model, composed of a short-term decision tree model and a long-term Markov model, was developed for patients who underwent PCI to treat intermediate stenosis (40% to 70% stenosis by visual estimation on coronary angiography).The lifetime healthcare costs and quality-adjusted life-years (QALYs) were estimated from the healthcare system perspective. Transition probabilities were mainly referred from the FLAVOUR trial, and healthcare costs were mainly obtained through analysis of Korean National Health Insurance claims data. Health utilities were mainly obtained from the Seattle Angina Questionnaire responses of FLAVOUR trial participants mapped to EQ-5D.
Results:From the Korean healthcare system perspective, the base-case analysis showed that FFR-guided PCI was 2,451 U.S. dollar lower in lifetime healthcare costs and 0.178 higher in QALYs compared to IVUS-guided PCI. FFR-guided PCI remained more likely to be cost-effective over a wide range of willingness-to-pay thresholds in the probabilistic sensitivity analysis.
Conclusions:Based on the results from the FLAVOUR trial, FFR-guided PCI is projected to decrease lifetime healthcare costs and increase QALYs compared with IVUS-guided PCI in intermediate coronary lesion, and it is a dominant strategy in Korea.
