Catheter-based renal denervation was projected to be cost-effective for resistant hypertension compared to standard of care, with a lifetime incremental cost-effectiveness ratio of $3,071 per QALY.
Effect estimate: ICER $3,071/QALY (95% CI cost-saving to 31,460)
OBJECTIVES: The purpose of this study was to assess cost-effectiveness and long-term clinical benefits of renal denervation in resistant hypertensive patients. BACKGROUND: Resistant hypertension affects 12% of hypertensive persons. In the Symplicity HTN-2 randomized controlled trial, catheter-based renal denervation (RDN) lowered systolic blood pressure by 32 ± 23 mm Hg from 178 ± 18 mm Hg at baseline. METHODS: A state-transition model was used to predict the effect of RDN and standard of care on 10-year and lifetime probabilities of stroke, myocardial infarction, all coronary heart disease, heart failure, end-stage renal disease, and median survival. We adopted a societal perspective and estimated an incremental cost-effectiveness ratio in U. S. dollars per quality-adjusted life-year, both discounted at 3% per year. Robustness and uncertainty were evaluated using deterministic and probabilistic sensitivity analyses. RESULTS: Renal denervation substantially reduced event probabilities (10-year/lifetime relative risks: stroke 0. 70/0. 83; myocardial infarction 0. 68/0. 85; all coronary heart disease 0. 78/0. 90; heart failure 0. 79/0. 92; end-stage renal disease 0. 72/0. 81). Median survival was 18. 4 years for RDN versus 17. 1 years for standard of care. The discounted lifetime incremental cost-effectiveness ratio was 3, 071 per quality-adjusted life-year. Findings were relatively insensitive to variations in input parameters except for systolic blood pressure reduction, baseline systolic blood pressure, and effect duration. The 95% credible interval for incremental cost-effectiveness ratio was cost-saving to 31, 460 per quality-adjusted life-year. CONCLUSIONS: The model suggests that catheter-based renal denervation, over a wide range of assumptions, is a cost-effective strategy for resistant hypertension that might result in lower cardiovascular morbidity and mortality.
“Renal denervation therapy falls into that category if you consider, of course, that hypertension is the global leading cause of death and disability and we can achieve quite meaningful reductions in blood pressure with renal denervation therapy. As long as the costs of the procedure and the device and the safety of the procedure are acceptable and reasonable, which they all of course are, then the therapy is what might be deemed a dominant or high-value, cost-effective therapy.”
Geisler et al. (Wed,) conducted a other in Resistant hypertension. Catheter-based renal denervation vs. Standard of care was evaluated on Incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) (ICER $3,071/QALY, 95% CI cost-saving to 31,460). Catheter-based renal denervation was projected to be cost-effective for resistant hypertension compared to standard of care, with a lifetime incremental cost-effectiveness ratio of $3,071 per QALY.