OBJECTIVES: The introduction of fractional flow reserve derived from coronary computed tomography (FFRct) could provide a non-invasive alternative to current diagnostics in patients with stable chest pain in The Netherlands. The aim of this study was to assess the healthcare costs and effects of Hemolens’ FFRct guided diagnostics compared to standard diagnostics.

METHODS: A decision-tree model was developed to calculate the costs from the hospital perspective, probability of correct diagnoses, and risk of major adverse cardiac events (MACE) after one year. The costs included were clinician time, disposables, equipment, medications, and treatments. Total costs for 2022 were calculated using a micro costing approach. One-way sensitivity analyses were conducted to determine the main cost drivers. To determine the added price of FFRct analysis (computational analysis only, excluding CT scan) at which point both strategies are equal in costs a threshold analysis was conducted.

RESULTS: The mean one-year costs were €3,479 for FFRct and €3,708 for standard diagnostics. The one-year probability of correct diagnoses was 0.82 and 0.71, respectively. The one-year risk of MACE was 0.0006 for FFRct and 0.01 for standard diagnostics. One-way sensitivity analyses showed that the main drivers of the difference in costs between the strategies were the probabilities and costs of revascularization, and test characteristics of FFRct and coronary computed tomography angiography (CCTA). The threshold analysis indicated that the added price of FFRct analysis should be below €955 per procedure to be considered the least costly option.

CONCLUSIONS: These early HTA findings suggest that FFRct may reduce healthcare spending, probability of an incorrect diagnosis, and MACE compared to current diagnostics for patients with stable chest pain in the Dutch healthcare setting. Future cost-effectiveness studies could determine a value-based pricing for FFRct and quantify the economic value of the anticipated therapeutic impact.