Cost-effectiveness of angiographic quantitative flow ratio-guided coronary intervention: A multicenter, randomized, sham-controlled trial.

Yanyan ZHAO; Changdong GUAN; Yang WANG; Zening JIN; Bo YU; Guosheng FU; Yundai CHEN; Lijun GUO; Xinkai QU; Yaojun ZHANG; Kefei DOU; Yongjian WU; Weixian YANG; Shengxian TU; Javier ESCANED; William F FEARON; Shubin QIAO; David J COHEN; Harlan M KRUMHOLZ; Bo XU; Lei SONG

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Cost-effectiveness of angiographic quantitative flow ratio-guided coronary intervention: A multicenter, randomized, sham-controlled trial.

Author: Yanyan ZHAO ¹ ; Changdong GUAN ² ; Yang WANG ¹ ; Zening JIN ³ ; Bo YU ⁴ ; Guosheng FU ⁵ ; Yundai CHEN ⁶ ; Lijun GUO ⁷ ; Xinkai QU ⁸ ; Yaojun ZHANG ⁹ ; Kefei DOU ² ; Yongjian WU ² ; Weixian YANG ² ; Shengxian TU ¹⁰ ; Javier ESCANED ¹¹ ; William F FEARON ¹² ; Shubin QIAO ² ; David J COHEN ¹³ ; Harlan M KRUMHOLZ ¹⁴ ; Bo XU ² ; Lei SONG ²
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1. Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing 100037, China.
2. Department of Cardiology, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
3. Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
4. Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, China.
5. Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310016, China.
6. Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China.
7. Department of Cardiology, Peking University Third Hospital, Beijing 100191, China.
8. Department of Cardiology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China.
9. Department of Cardiology, Xuzhou Third People's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221005, China.
10. Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200025, China.
11. Hospital Clínico San Carlos IDISSC, Complutense University of Madrid, Madrid 28040, Spain.
12. Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine and VA Palo Alto Health Care System, Palo Alto, CA 94305, USA.
13. Cardiovascular Research Foundation, New York, NY 10019, USA.
14. Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
Collective Name:FAVOR III China Study Group
Publication Type:Multicenter Study
Keywords: Coronary artery disease; European Quality of Life-5 Dimensions; Incremental cost-effectiveness ratio; Major adverse cardiac and cerebrovascular events; Percutaneous coronary intervention; Quality-adjusted life-years; Quantitative flow ratio
MeSH: Humans; Cost-Benefit Analysis; Percutaneous Coronary Intervention/methods*; Male; Female; Coronary Angiography/methods*; Middle Aged; Aged; Coronary Artery Disease/surgery*; Quality-Adjusted Life Years; Fractional Flow Reserve, Myocardial/physiology*
From: Chinese Medical Journal 2025;138(10):1186-1193
CountryChina
Language:English
Abstract: BACKGROUND:The FAVOR (Comparison of Quantitative Flow Ratio Guided and Angiography Guided Percutaneous Intervention in Patients with Coronary Artery Disease) III China trial demonstrated that percutaneous coronary intervention (PCI) lesion selection using quantitative flow ratio (QFR) measurement, a novel angiography-based approach for estimating fractional flow reserve, improved two-year clinical outcomes compared with standard angiography guidance. This study aimed to assess the cost-effectiveness of QFR-guided PCI from the perspective of the current Chinese healthcare system.
METHODS:This study is a pre-specified analysis of the FAVOR III China trial, which included 3825 patients randomized between December 25, 2018, and January 19, 2020, from 26 centers in China. Patients with stable or unstable angina pectoris or those ≥72 hours post-myocardial infarction who had at least one lesion with a diameter stenosis between 50% and 90% in a coronary artery with a ≥2.5 mm reference vessel diameter by visual assessment were randomized to a QFR-guided strategy or an angiography-guided strategy with 1:1 ratio. During the two-year follow-up, data were collected on clinical outcomes, quality-adjusted life-years (QALYs), estimated costs of index procedure hospitalization, outpatient cardiovascular medication use, and rehospitalization due to major adverse cardiac and cerebrovascular events (MACCE). The primary analysis calculated the incremental cost-effectiveness ratio (ICER) as the cost per MACCE avoided. An ICER of ¥10,000/MACCE event avoided was considered economically attractive in China.
RESULTS:At two years, the QFR-guided group demonstrated a reduced rate of MACCE compared to the angiography-guided group (10.8% vs . 14.7%, P <0.01). Total two-year costs were similar between the groups (¥50,803 ± 21,121 vs . ¥50,685 ± 23,495, P = 0.87). The ICER for the QFR-guided strategy was ¥3055 per MACCE avoided, and the probability of QFR being economically attractive was 64% at a willingness-to-pay threshold of ¥10,000/MACCE avoided. Sensitivity analysis showed that QFR-guided PCI would become cost-saving if the cost of QFR were below ¥3682 (current cost: ¥3800). Cost-utility analysis yielded an ICER of ¥56,163 per QALY gained, with a 53% probability of being cost-effective at a willingness-to-pay threshold of ¥85,000 per QALY gained.
CONCLUSION:In patients undergoing PCI, a QFR-guided strategy appears economically attractive compared to angiographic guidance from the perspective of the Chinese healthcare system.
TRIAL REGISTRATION:ClinicalTrials.gov , NCT03656848.