The purpose of this study was to assess cost-effectiveness and long-term clinical benefits of renal denervation in resistant hypertensive patients. 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. 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. 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. 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.
Journal of the American College of Cardiology Current Issue
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