A simulation model to measure the impact of introducing new procedures in cardiology

Introduction Percutaneous coronary interventions (PCI), like angioplasty or stents, are well established and reflected in DRG payment. However, recent scientific evidence shows that a significant number of patients having socalled intermediate stenoses (i.e., a stenosis diameter bt. 40%–70% of the total coronary calibre) do not necessarily profit from PCI. A diagnostic test – the measurement of the coronary flow reserve (FFR) is available. The FAME study (Fractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary Intervention, Tonino et.al., N Engl J Med 2009;360:213-24) showed that refusing PCI in an intermediate stenosis where the FFR is > 0.8 results in better outcomes than performing PCI. There is strong evidence for using FFR before performing a PCI in an intermediate stenosis. On the other hand, FFR itself causes costs (approximately € 900). The procedure code for FFR is already incorporated in the German DRG system, Version 2010. The research questions in this setting were: