REAL-WORLD IMPACT OF CT-DERIVED FRACTIONAL FLOW RESERVE IN A CTCA-FIRST PATHWAY IN SCOTLAND
Author(s)
Apurva Sinha, MD1, Marcus Kam, MD1, Daniel D'Attilio, MA2, Ralf Velden, Dipl.-Ing. (FH)2, Tomasz Waszyrowski, MD1.
1NHS Borders, Melrose, United Kingdom, 2Heartflow Inc., Mountain View, CA, USA.
1NHS Borders, Melrose, United Kingdom, 2Heartflow Inc., Mountain View, CA, USA.
OBJECTIVES: Computed tomography coronary angiography (CTCA) is central to coronary artery disease assessment; however, anatomical evaluation alone often leads to unnecessary invasive coronary angiography (ICA). This inefficiency exacerbates capacity constraints, with Scottish cardiology waits averaging 10.3 weeks. CT-derived fractional flow reserve (ctFFR) provides lesion-specific physiological assessment. This study evaluates the clinical, economic, and operational capacity impact of ctFFR in a real-world setting.
METHODS: A retrospective two-cycle audit at NHS Borders compared CTCA+ctFFR (Cycle 1, n=83; Mar 2022-Jun 2023) with CTCA alone (Cycle 2, n=153; Jun 2024-Jul 2025). The primary outcome was ICA referral among patients categorized as positive/indeterminate. A cost-consequence model used the £2,369 NHS ICA tariff and £527 ctFFR unit cost, scaled to a 10,000-patient cohort. Capacity analysis projected the impact of avoided ICAs against a 133-patient >52-week elective cardiology backlog. Chi-squared testing compared referral rates, and a one-way sensitivity analysis evaluated parameter sensitivity.
RESULTS: CTCA results were indeterminate in 38.6% of Cycle 1 patients. ICA referral rates among positive/indeterminate cases were 37.0% (Cycle 1) versus 57.4% (Cycle 2); OR 0.436 (95% CI 0.202-0.944), p=0.034. Per 100 patients, ctFFR avoided 20.4 ICAs, saving £14,020 net. Scaled to 10,000 patients, this requires 6,510 ctFFR tests but yields 2,040 avoided ICAs, generating £4.83 million in gross savings and £1.40 million in net savings. Operationally, these 2,040 avoided ICAs annually (~39/week) rescue sufficient capacity to clear the 133-patient >52-week backlog in under four weeks, or accommodate 1,020 additional therapeutic PCI procedures. One-way sensitivity analysis confirmed net savings across all scenarios.
CONCLUSIONS: Integrating ctFFR into the diagnostic pathway significantly reduces unnecessary ICA referrals while demonstrating a net cost reduction. These findings demonstrate that a CCTA-First pathway with ctFFR effectively reduces procedural backlogs and optimizes cath lab capacity for therapeutic interventions.
METHODS: A retrospective two-cycle audit at NHS Borders compared CTCA+ctFFR (Cycle 1, n=83; Mar 2022-Jun 2023) with CTCA alone (Cycle 2, n=153; Jun 2024-Jul 2025). The primary outcome was ICA referral among patients categorized as positive/indeterminate. A cost-consequence model used the £2,369 NHS ICA tariff and £527 ctFFR unit cost, scaled to a 10,000-patient cohort. Capacity analysis projected the impact of avoided ICAs against a 133-patient >52-week elective cardiology backlog. Chi-squared testing compared referral rates, and a one-way sensitivity analysis evaluated parameter sensitivity.
RESULTS: CTCA results were indeterminate in 38.6% of Cycle 1 patients. ICA referral rates among positive/indeterminate cases were 37.0% (Cycle 1) versus 57.4% (Cycle 2); OR 0.436 (95% CI 0.202-0.944), p=0.034. Per 100 patients, ctFFR avoided 20.4 ICAs, saving £14,020 net. Scaled to 10,000 patients, this requires 6,510 ctFFR tests but yields 2,040 avoided ICAs, generating £4.83 million in gross savings and £1.40 million in net savings. Operationally, these 2,040 avoided ICAs annually (~39/week) rescue sufficient capacity to clear the 133-patient >52-week backlog in under four weeks, or accommodate 1,020 additional therapeutic PCI procedures. One-way sensitivity analysis confirmed net savings across all scenarios.
CONCLUSIONS: Integrating ctFFR into the diagnostic pathway significantly reduces unnecessary ICA referrals while demonstrating a net cost reduction. These findings demonstrate that a CCTA-First pathway with ctFFR effectively reduces procedural backlogs and optimizes cath lab capacity for therapeutic interventions.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HSD77
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Medical Technologies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas