Sharp ASP, Cao KN, Esler MD, Kandzari DE, Lobo MD, Schmieder RE, Pietzsch JB, Cost-effectiveness of catheter-based radiofrequency renal denervation for the treatment of uncontrolled hypertension: an analysis for the UK based on recent clinical evidence. Eur Heart J Qual Care Clin Outcomes. 9 January 2024; doi: 10.1093/ehjqcco/qcae001

Aims. Catheter-based radiofrequency renal denervation (RF RDN) has recently been approved for clinical use in the European Society of Hypertension guidelines and by FDA. This study evaluated the lifetime cost-effectiveness of RF RDN using contemporary evidence.

Methods and Results. A decision-analytic model based on multivariate risk equations projected clinical events, quality-adjusted life years (QALYs), and costs. The model consisted of seven health states: hypertension alone, myocardial infarction (MI), other symptomatic coronary artery disease, stroke, heart failure (HF), end-stage renal disease, and death. Risk reduction associated with changes in office systolic blood pressure (oSBP) was estimated based on a published meta-regression of hypertension trials. The base case effect size of –4.9 mmHg oSBP (observed vs. sham control) was taken from the SPYRAL HTN-ON MED trial of 337 patients. Costs were based on NHS England data.

The incremental cost-effectiveness ratio (ICER) was evaluated against the NICE cost-effectiveness threshold of £20,000–₤30,000 per QALY gained. Extensive scenario and sensitivity analyses were conducted, including the ON-MED subgroup on three medications and pooled effect sizes. RF RDN resulted in a relative risk reduction in clinical events over 10 years (0.80 for stroke, 0.88 for MI, 0.72 for HF), with an increase in health benefit over a patient’s lifetime, adding 0.35 QALYs at a cost of £4,763, giving an ICER of £13,482 per QALY gained. Findings were robust across tested scenarios.

Conclusion. Catheter-based radiofrequency RDN can be a cost-effective strategy for uncontrolled hypertension in the UK, with an ICER substantially below the NICE cost-effectiveness threshold.