Cost-effectiveness and clinical effectiveness of catheter-based renal denervation for resistant hypertension

Benjamin P. Geisler, Brent M. Egan, Joshua T. Cohen, Abigail M. Garner, Ronald L. Akehurst, Murray D. Esler, Jan B. Pietzsch

Research output: Contribution to journalArticle

103 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1271-1277
Number of pages7
JournalJournal of The American College of Cardiology
Volume60
Issue number14
DOIs
Publication statusPublished - 2 Oct 2012
Externally publishedYes

Keywords

  • autonomic denervation
  • cost-benefit analysis
  • decision support techniques
  • hypertension
  • renal artery

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