Geisler BP, Egan BM, Cohen JT, Garner AM, Akehurst RL, Esler MD, Pietzsch JB. Cost-effectiveness and clinical effectiveness of catheter-based renal denervation for resistant hypertension. J Am Coll Cardiol. 2012;60(14):1271–1277; doi: 10.1016/j.jacc.2012.07.029.

Objectives. 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. The purpose of this study was to assess cost-effectiveness and long-term clinical benefits of renal denervation in resistant hypertensive patients.

Methods. A state-transition (Markov) model was used to predict the effect of RDN and standard of care on 10-year and lifetime probabilities of all coronary heart disease, end-stage renal disease, heart failure, myocardial infarction, stroke, 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. The 10-year/lifetime relative risks: all coronary heart disease 0.78/0.90; end-stage renal disease 0.72/0.81; heart failure 0.79/0.92; myocardial infarction 0.68/0.85; stroke 0.70/0.83). 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.