Cost and Quality-of-Life PLATFORM Data Support FFRCT

October 13, 2015—Cost and quality-of-life outcomes from the PLATFORM trial were reported at TCT 2015, the 27th annual Transcatheter Cardiovascular Therapeutics scientific symposium of the Cardiovascular Research Foundation being held October 11–15, in San Francisco, California. The study was also published by Mark A. Hlatky, MD, et al online ahead of print in the Journal of the American College of Cardiology.

The results from the multicenter, prospective PLATFORM (Prospective Longitudinal Trial of FFRCT: Outcomes and Resource Impacts) study show that assessing fractional flow reserve estimated with computed tomography (FFRCT) may reduce costs in selected symptomatic patients with suspected coronary artery disease (CAD). PLATFORM has previously demonstrated the clinical effectiveness of using FFRCT to guide CAD, compared with conventional testing. FFRCT was recently approved for clinical use by the US Food and Drug Administration and received CE Mark approval in Europe, noted TCT.

The purpose of this study was to assess the economic and quality of life outcomes of evaluation strategies that use FFRCT, based on data collected prospectively from the nonrandomized PLATFORM study. The study was composed of 584 symptomatic patients with suspected CAD who were enrolled at 11 European centers (204 in the planned noninvasive testing stratum and 380 in the planned invasive testing stratum). 

Within the planned noninvasive testing stratum, 100 patients were evaluated with the usual care strategy, and 104 patients were evaluated with the FFRCT strategy. In the planned invasive testing stratum, 187 patients were evaluated with the usual care strategy, and 193 patients were evaluated with the FFRCT strategy.

The number of diagnostic tests, invasive procedures, hospitalizations, and medications after 90 days were multiplied by United States cost weights and summed to derive total medical costs. Changes in quality of life (QOL) from baseline to 90 days were assessed using the Seattle Angina Questionnaire (SAQ), the EuroQOL (EQ-5D), and a visual analog scale (VAS).

In the 584 patients, 74% had atypical angina, and the pretest probability of coronary disease was 49%. In the planned invasive stratum, mean costs were 32% lower among the FFRCT patients than among the usual care patients who typically underwent invasive coronary angiography ($7,343 vs $10,734; P < .0001). In the noninvasive stratum, mean costs were not significantly different between the FFRCT patients and the usual care patients who underwent traditional noninvasive risk stratification ($2,679 vs $2,137; P = .26).

In a sensitivity analysis, when the cost weight of FFRCT was set to seven times that of CT angiography, the FFRCT group still had lower costs than in the usual care group in the invasive testing stratum ($8,619 vs $10,734; P < .0001), while in the noninvasive testing stratum, when the cost weight of FFRCT was set to half that of CT angiography, the FFRCT group had higher costs than the usual care group ($2,766 vs $2,137; P = .02).

Each QOL score improved in the overall study population (P < .0001). In the noninvasive stratum, QOL scores improved more in FFRCT patients than in usual care patients: SAQ, 19.5 vs 11.4 (P = .003); EQ-5D, .08 vs .03 (P = .002); and VAS, 4.1 vs 2.3 (P = .82). In the invasive cohort, the improvements in QOL were similar in the FFRCT and usual care patients.

Dr. Hlatky, the study’s lead investigator, commented in the TCT press release, “These results suggest that use of FFRCT might reduce overall costs and improve patient quality of life. Larger, randomized studies are warranted to compare the clinical effectiveness of management strategies based on use of FFRCT with management strategies based on using other methods of anatomic or functional evaluation.” Dr. Hlatky is Professor of Health Research and Policy and Professor of Medicine at the Stanford University School of Medicine in Stanford, California.