Technical / NICE update

Mortality from coronary artery disease is the biggest single cause of death in the UK, writes Nicola Bodey.

In 2014, 15% of male deaths and 10% of female deaths were the result of coronary artery disease (around 69,000 total deaths). British Heart Foundation figures for 2011 showed that 5.7% of all men (aged 16 and over) and 3.5% of all women in England had coronary artery disease.

Coronary CT angiography (CCTA) is a type of scan that shows detailed pictures of the heart and its blood vessels. HeartFlow FFRCT – the technology covered in new medical technologies guidance, MTG32 – is a computer program that uses images from the CCTA scan to estimate fractional flow reserve (FFR). This can help to identify narrowed blood vessels and better inform future treatment. 

It may avoid the requirement for other non-invasive tests, invasive coronary angiography and revascularisation, which would result in savings to commissioners and providers.

Using HeartFlow FFRCT requires access to 64-slice (or above) coronary CT angiography facilities. NICE estimates that about 89,300 people are eligible for HeartFlow FFRCT each year. From year five after implementation, it estimates some 35,600 people will have HeartFlow FFRCT each year (based on 100% uptake). Savings for commissioners are estimated to be £1.8m in England in the first year of implementation, increasing to £9.1m in England from five years following implementation. This is equivalent to £16,800 per 100,000 population.

There is currently no national tariff for HeartFlow FFRCT. Uncertainties around funding flows for provider organisations may be a barrier to implementation of the technology. Commissioners are encouraged to work with provider organisations to develop a local tariff to establish the use of HeartFlow FFRCT in interventional cardiology service provision. 

This technology is commissioned by clinical commissioning groups. Providers are NHS hospital trusts.

Nicola Bodey is a senior business analyst at NICE