Cost-Effectiveness and Clinical Effectiveness of Catheter-Based Renal Denervation for Resistant Hypertension

• Published in: Journal of the American College of Cardiology Vol. 60; no. 14; pp. 1271 - 1277
• Main Authors: Geisler, Benjamin P., MD, MPH, Egan, Brent M., MD, Cohen, Joshua T., PhD, Garner, Abigail M., MS, Akehurst, Ronald L., MFPHM, Esler, Murray D., MBBS, PhD, Pietzsch, Jan B., PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 02-10-2012; Elsevier; Elsevier Limited
• Subjects: Aged; Arterial hypertension. Arterial hypotension; autonomic denervation; Biological and medical sciences; Blood and lymphatic vessels; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cardiovascular Diseases - mortality; Catheterization; Cholesterol; Cohort Studies; Cost-Benefit Analysis; Decision Support Techniques; Drug therapy; Female; Heart attacks; Humans; hypertension; Hypertension - economics; Hypertension - surgery; Internal Medicine; Kidney - innervation; Male; Markov Chains; Medical sciences; Middle Aged; Mortality; Older people; Quality-Adjusted Life Years; renal artery; Reproducibility of Results; Risk; Sympathectomy - economics; Treatment Outcome; ESRD; quality-adjusted life-year; RCT; high-density lipoprotein; SoC; myocardial infarction; risk difference; systolic blood pressure; HDL; cost-benefit analysis; renal artery; MI; RDN; PSA; SBP; cardiovascular disease; heart failure; renal denervation; ICER; standard of care; National Institute for Clinical Excellence; end-stage renal disease; autonomic denervation; randomized controlled trial; CVD; probabilistic sensitivity analysis; RD; decision support techniques; QALY; incremental cost-effectiveness ratio; NICE; coronary heart disease; hypertension; CHD; HF; Hypertension; Resistance; Health economy; Catheter; Cardiovascular disease; Circulatory system; Cardiology; Public health; Kidney; Cost efficiency analysis; Denervation
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2012.07.029

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.