Justin Davies, MBBS: The DEFINE-FLAIR Study's Cost Analysis

At ACC.18 in Orlando, Florida, Justin Davies, MBBS, MRCP, PhD, an interventional cardiologist at the Hammersmith Hospital of Imperial College in London, sat with MD Magazine to discuss the cost-effectiveness analysis of the DEFINE-FLAIR trial, comparing instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) for patients requiring percutaneous coronary intervention (PCI).

All told, the study found that 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.

Justin Davies, MBBS, MRCP, PhD, an interventional cardiologist at the Hammersmith Hospital of Imperial College in London:

"This is the health economics pre-specified analysis of the DEFINE-FLAIR study. If you're not familiar with the DEFINE-FLAIR study, it first reported it the ACC last year and it was the largest clinical trial today in coronary physiology comparing the FFR guided approach with an iFR guided approach and at that time just looking at hard clinical outcomes—death, myocardial infarction, unplanned revascularization.

"This year, what we're looking at are the cost implications of using either an iFR guided approach or an FFR guided approach—so what are the differences? We know there was about a 5% reduction in revascularisation with iFR. We know that there were different patients coming back in with unplanned revascularization. We know that are slightly more CABG in the FFR group than the iFR group. All of these things going to go into the mix for the health economics analysis to actually see what's the bottom line, which one of these is more expensive than the other, and is there a significant difference between the 2?

"I think perhaps the scale of the finding was surprising and there's a very significant reduction in costs using an iFR approach to an FFR guided approach, and this is multifactorial at every level. Whether it's from a diagnostic positioning, all the way through to the procedural choices of revascularization, all the way through to unplanned revascularization, which is needed at the end.

"Alongside this analysis, a quality of life assessment [was also presented] comparing, again, FFR with iFR and this was very pleasing to see that it mirrored the initial results, and [it] showed no significant differences between using FFR or iFR guided approach as well.

You always get debates and discussion when there's a conflict between 2 different ways of doing things, so I think that any time where there's significant challenge of the old by something new, this happens. With regards to the FLAIR data and healthy economics data, I don't suspect that will be too much of a major bone of contention. I think it may be a surprise in terms of the magnitude of the savings because that's got profound implication for health care costs, but I don't think there's going to be some kind of huge discussions or arguments around this."