Treatment strategy modification and its implication on the medical cost of fractional flow reserve-guided percutaneous coronary intervention in Japan

Nobuhiro Tanaka, Shun Kosaka, Tatsunori Murata, Takashi Akasaka, Kazushige Kadota, Shirou Uemura, Tetsuya Amano, Nobuo Shiode, Yoshihiro Morino, Kenshi Fujii, Yutaka Hikichi, Masato Nakamura

Research output: Contribution to journalArticle

Abstract

Background: Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) could improve outcome compared with angiography-guided PCI. However, the economic impact of FFR-guided PCI remains largely unknown in the medical system in Japan. We evaluated the impact of treatment strategy modification by FFR measurement on the direct medical cost using a model analysis with a decision tree model in Japan. Methods: For the clinical parameters set in the model, the findings from CVIT-DEFER registry were adopted. Cost parameters were considered on the assumption that coronary angiography, FFR measurement, and the treatment are performed at Diagnosis Procedure combination (DPC) hospitals, and the costs were calculated based on the medical fee reimbursement systems in Japan. Results: The probability of deferral of PCI in patients who were allocated to PCI based on coronary angiography was set as 90.1% based on the CVIT-DEFER registry. In the model analysis, the cost of tests was increased by 185,660 JPY per patient by the addition of FFR measurement, but the cost of treatment with PCI was reduced by 561,425 JPY per patient, and the entire cost of treatment was reduced by 322,675 JPY, resulting in the expected reduction in the total expected medical cost by 137,015 JPY per patient. Conclusion: Under contemporary Japanese practice, FFR-guided PCI has potential to reduce the medical cost by effective reassessment of coronary stenosis and reducing inappropriate application of PCI.

Original languageEnglish
JournalJournal of Cardiology
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Percutaneous Coronary Intervention
Japan
Costs and Cost Analysis
Therapeutics
Coronary Angiography
Health Care Costs
Registries
Medical Fees
Decision Trees
Hospital Costs
Coronary Stenosis
Angiography
Economics

Keywords

  • Coronary artery stenosis
  • Fractional flow reserve
  • Medical cost
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Treatment strategy modification and its implication on the medical cost of fractional flow reserve-guided percutaneous coronary intervention in Japan. / Tanaka, Nobuhiro; Kosaka, Shun; Murata, Tatsunori; Akasaka, Takashi; Kadota, Kazushige; Uemura, Shirou; Amano, Tetsuya; Shiode, Nobuo; Morino, Yoshihiro; Fujii, Kenshi; Hikichi, Yutaka; Nakamura, Masato.

In: Journal of Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

Tanaka, Nobuhiro ; Kosaka, Shun ; Murata, Tatsunori ; Akasaka, Takashi ; Kadota, Kazushige ; Uemura, Shirou ; Amano, Tetsuya ; Shiode, Nobuo ; Morino, Yoshihiro ; Fujii, Kenshi ; Hikichi, Yutaka ; Nakamura, Masato. / Treatment strategy modification and its implication on the medical cost of fractional flow reserve-guided percutaneous coronary intervention in Japan. In: Journal of Cardiology. 2018.
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AU - Kosaka, Shun

AU - Murata, Tatsunori

AU - Akasaka, Takashi

AU - Kadota, Kazushige

AU - Uemura, Shirou

AU - Amano, Tetsuya

AU - Shiode, Nobuo

AU - Morino, Yoshihiro

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