FFR Guided Functionally complete
revascularisation:
Safe, Efficacious AND cost effective?
Markus Siebert,
Director Reimbursement & Health Economics EMEAC, St. Jude Medical
Conflicts of Interest
Employee of St. Jude Medical
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Clinical effectiveness
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DEFER: 5-year follow up data
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FAME: 2-year follow up data
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Slides 5-8 courtesy Nico H.J. Pijls, MD,PhD, FAME study PI.
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Clinical Guidelines changes:
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Clinical Guidelines changes:
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Cost-effectiveness
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Health Economics FFR single vessel - US
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MSAC (Australia) HTA on FFR and CFR - 2006
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Cost-Effectiveness in MSAC HTA
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Siebert et al: German HTA on FFR,
incl HE model on single-vessel patients (2008)
Methods: Markov model, life-time horizon, Statutory Health Insurance’s
perspective, FFR vs universal PCI in all patients
Results:
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Cohort
Incr QALD
FFR vs PCI
Incr cost FFR vs
PCI
ICER
(cost/QALY)
30y, m/w
9.8
€936
€35,000
40y, m/w
9.0
€757
€31,000
50y, m/w
7.6
€516
€25,000
60y, m/w
5.0
€214
€16,000
70y, m/w
2.2
- €107
FFR dominant
DIMDI HTA Report on FFR (2008)
"Also Peter Sawicki, head of
IQWIG, considers the study
important. This investigation would
be "an example for medical
progress leading to a reduction of
spending in health care systems"
said Sawicki to SPIEGEL ONLINE.
"Now we should think about
introducing FFR measurement as
quality criterion before stent
implantation".
Source: Spiegel Online, 15 Jan 2009
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Future research on country-specific cost-effectiveness FFR
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Rationale
Initial cost-effectiveness work for the US and Germany based on
DEFER and FAME shows that FFR is highly cost-effective or even
cost-saving (better results, lower costs): additional evidence of this
kind is needed for individual countries.
In addition to cost-effectiveness, the research will also focus on the
budget impact for the health care payer of integrating FFR into the
CAD treatment pathway in a respective country.
Another aspect will be the health impact of FFR on society: Based on
the annual incidence of coronary artery disease in a country, the
analysis will extrapolate the total number of MACE events that could
be avoided through systematic use of FFR.
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Research approach
The economic evaluations will be the result of health economic
(Markov) modelling. This analysis will be performed as an
unrestricted research grant and will be based on original patient
data from the FAME trial.
Clinical effectiveness and resource utilisation (e.g. number of stents
implanted or doctor’s visits during follow up period) will be taken and
multiplied with country-specific cost data, e.g. UK.
This approach will deliver health economic results that reflect local
cost realities and that should be acceptable to local decisionmakers. The perspective for the analysis will be that of the national
health care payer.
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Thank you
msiebert@sjm.com
+32 476 565 101
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