| Institution: | 1. Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York;2. Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India;3. Division of Cardiology, Montefiore Medical Center, Albert Einstein Medical College, New York, New York;4. Department of Medicine, Hackensack University Medical Center, Hackensack, New Jersey;5. Division of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan;6. Scientist-D, ICMR- National Institute of Epidemiology, Chennai, India;7. Department of Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, India;8. Department of Cardiology, University Sapienza of Rome, Rome, Italy;9. Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands;10. Department of Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York;1. Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Denmark;2. Department of Cardiology, Odense University Hospital, Odense, Denmark;3. Department of Cardiology, Oulu University Hospital, University of Oulu, Finland;4. Department of Cardiology, Aalborg University Hospital, Denmark;5. Department of Medicine, Karolinska Institutet, Stockholm, Sweden;6. Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden;7. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden;8. The Danish Heart Foundation;9. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark;10. Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland;11. Department of Cardiology, Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden;12. Heart Center, Turku University Hospital, Finland;13. University of Latvia, Riga, Latvia;14. Department of Clinical Medicine, University of Copenhagen, Denmark |
| Abstract: | BackgroundFFRCT assesses the functional significance of lesions seen on CTCA, and may be a more efficient approach to chest pain evaluation. The FORECAST randomized trial found no significant difference in costs within the UK National Health Service, but implications for US costs are unknown. The purpose of this study was to compare costs in the FORECAST trial based on US healthcare cost weights, and to evaluate factors affecting costs.MethodsPatients with stable chest pain were randomized either to the experimental strategy (CTCA with selective FFRCT), or to standard clinical pathways. Pre-randomization, the treating clinician declared the planned initial test. The primary outcome was nine-month cardiovascular care costs.ResultsPlanned initial tests were CTCA in 912 patients (65%), stress testing in 393 (28%), and invasive angiography in 94 (7%). Mean US costs did not differ overall between the experimental strategy and standard care (cost difference +7% (+$324), CI ?12% to +26%, p ?= ?0.49). Costs were 4% lower with the experimental strategy in the planned invasive angiography stratum (p for interaction ?= ?0.66). Baseline factors independently associated with costs were older age (+43%), male sex (+55%), diabetes (+37%), hypertension (+61%), hyperlipidemia (+94%), prior angina (+24%), and planned invasive angiography (+160%). Post-randomization cost drivers were coronary revascularization (+348%), invasive angiography (267%), and number of tests (+35%).ConclusionsInitial evaluation of chest pain using CTCA with FFRCT had similar US costs as standard care pathways. Costs were increased by baseline coronary risk factors and planned invasive angiography, and post-randomization invasive procedures and the number of tests.Registration at ClinicalTrials.gov (NCT03187639). |
