Cost-Effectiveness and Clinical Effectiveness of Catheter-Based Renal Denervation for Resistant Hypertension
What is the cost-effectiveness and long-term clinical benefit of renal denervation (RDN) in patients with resistant hypertension?
The authors developed a state-transition model to predict the effect of RDN versus 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 applied to the Symplicity-2 trial. They adopted a societal perspective and estimated an incremental cost-effectiveness ratio in US dollars per quality-adjusted life-year, both discounted at 3% per year.
RDN was projected to substantially reduce clinical 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). The projected 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.
This modeling exercise suggests that catheter-based RDN would be a cost-effective strategy for resistant hypertension that would be associated with lower cardiovascular morbidity and mortality.
RDN is one of the most exciting new developments in cardiovascular medicine, and the results of the Simplicity-3 trial are eagerly awaited to help define the patient population that best benefits from this therapy. The results of this modeling exercise are not surprising, given the strong association between hypertension and adverse clinical outcomes, and the robust reduction in blood pressure that was seen with RDN in the Symplicity-2 trial.
Keywords: Myocardial Infarction, Stroke, Denervation, Standard of Care, Heart Failure, Hypertension
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