Original Article

Cardiovascular Intervention and Therapeutics

, Volume 30, Issue 1, pp 38-44

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Cost analysis of non-invasive fractional flow reserve derived from coronary computed tomographic angiography in Japan

  • Takeshi KimuraAffiliated withDepartment of Cardiovascular Medicine, Kyoto University Graduate School of Medicine Email author 
  • , Hiroki ShiomiAffiliated withDepartment of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
  • , Sachio KuribayashiAffiliated withDepartment of Radiology, Keio University School of Medicine
  • , Takaaki IsshikiAffiliated withDepartment of Cardiology, Teikyo University Hospital
  • , Susumu KanazawaAffiliated withDepartments of Radiology, Okayama University Graduate School of Medicine
  • , Hiroshi ItoAffiliated withDepartments of Cardiology, Okayama University Graduate School of Medicine
  • , Shunya IkedaAffiliated withInternational University of Health and Welfare
  • , Ben ForrestAffiliated withHeartFlow, Inc.
  • , Christopher K. ZarinsAffiliated withHeartFlow, Inc.
    • , Mark A. HlatkyAffiliated withDepartment of Health Research and Policy, Stanford University School of Medicine
    • , Bjarne L. NorgaardAffiliated withDepartment of Cardiology, Aarhus University Hospital Skejby


Percutaneous coronary intervention (PCI) based on fractional flow reserve (FFRcath) measurement during invasive coronary angiography (CAG) results in improved patient outcome and reduced healthcare costs. FFR can now be computed non-invasively from standard coronary CT angiography (cCTA) scans (FFRCT). The purpose of this study is to determine the potential impact of non-invasive FFRCT on costs and clinical outcomes of patients with suspected coronary artery disease in Japan. Clinical data from 254 patients in the HeartFlowNXT trial, costs of goods and services in Japan, and clinical outcome data from the literature were used to estimate the costs and outcomes of 4 clinical pathways: (1) CAG-visual guided PCI, (2) CAG-FFRcath guided PCI, (3) cCTA followed by CAG-visual guided PCI, (4) cCTA-FFRCT guided PCI. The CAG-visual strategy demonstrated the highest projected cost ($10,360) and highest projected 1-year death/myocardial infarction rate (2.4 %). An assumed price for FFRCT of US $2,000 produced equivalent clinical outcomes (death/MI rate: 1.9 %) and healthcare costs ($7,222) for the cCTA-FFRCT strategy and the CAG-FFRcath guided PCI strategy. Use of the cCTA-FFRCT strategy to select patients for PCI would result in 32 % lower costs and 19 % fewer cardiac events at 1 year compared to the most commonly used CAG-visual strategy. Use of cCTA-FFRCT to select patients for CAG and PCI may reduce costs and improve clinical outcome in patients with suspected coronary artery disease in Japan.


Fractional flow reserve Non-invasive diagnosis Cost-effectiveness Computational fluid dynamics Coronary computed tomographic angiography