iFR More Cost-Effective Than FFR for Patients Requiring PCI

Manesh Patel, MD

While non-invasive instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) are both viable and efficacious in mapping out blockages, iFR has been shown to be much more cost-effective.

All told, the use of iFR can reportedly save each patient at least $800 compared to FFR, which was shown to have a mean cost of $75 more per procedure alone.

Before a stent can be implanted or a blockage cleared, utilization of FFR—the older of the 2 technologies—requires an injection of adenosine to dilate the blood vessels, which adds complexity and risk, as well as adding a greater expense.

"There are clear clinical advantages to using these technologies to map coronary physiology prior to coronary revascularization procedures, because they provide an accurate evaluation of the blockage, as well how best to treat it," senior researcher Manesh Patel, MD, said in a statement. "Unfortunately, there has been resistance to performing FFR in part due to the use of the vasodilator drug, so finding a good alternative is an important clinical step."

Patel, the chief of both cardiology and clinical pulmonology at Duke and member of the University’s Clinical Research Institute, noted that in the past few years, iFR has blossomed as a favorable alternative to FFR. The use of iFR does not require adenosine, instead relying on pressure measurements at specific intervals during the cardiac cycle.

The DEFINE-FLAIR trial, reported in 2017, served as the source for Patel and colleagues' data to present their case and compare the cost-effectiveness of the duo of procedures at the 67^th American College of Cardiology Scientific Sessions in Orlando, Florida. DEFINE-FLAIR enrolled almost 2500 patients to determine that when performed similarly, iFR would result in fewer patient symptoms prior, during, and post-procedure.

Patel and colleagues found that while FFR cost an average of $2564 per patient, iFR came in at a lower cost, averaging $2489 per patient. Overall health care costs for patients receiving iFR were $7442 compared to $8243 with FER, for an $801 total savings.

The procedure, they found, cost less due to the lack of the need for vasodilation therapy, a quicker timetable to perform, and less likelihood of percutaneous coronary intervention (PCI). Additionally, those receiving iFR also had lower rates of coronary artery bypass graft measures, and subsequently, lower rates of revascularization.

"Either of these 2 technologies improve outcomes for patients with coronary disease, but our study shows that iFR has cost savings with similar outcomes," Patel said. "This should help remove barriers to the more widespread clinical adoption of a technology that can provide physicians with a better conception of patients' unique coronary physiology."

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