Pietzsch JB, Geisler BP, Schmieder R, Egan BM. Cost-effectiveness threshold analysis of various age and systolic blood pressure reduction scenarios for renal denervation therapy. Presentation at EuroPCR 2016. EuroIntervention: EuroPCR Book of Abstracts. 2016.

Objectives. The effectiveness of catheter-based renal denervation therapy (RDN) for hypertension depends on the magnitude of systolic blood pressure (SBP) reduction, age, and risk factors for cardiovascular disease.

Methods and Results. We assessed the cost-effectiveness of RDN plus best medical therapy versus best medical therapy alone in various combinations of age, baseline SBP, and hypothetical SBP reductions.

A published decision-analytic model was used to compute incremental cost-effectiveness ratios (ICERs) based on projected lifetime costs and quality-adjusted life years (QALYs). Model-projected outcomes included angina, myocardial infarction, primary and secondary stroke, heart failure, and end-stage renal disease. Hypothetical effect sizes between –3 and –13 mmHg were studied in three age groups (40, 50, and 61 years), and three baseline SBPs (155, 160, and 165 mmHg).

For all modeled cohorts, we assumed a common gender and risk factor profile based on recent data from the global Symplicity registry (60% male, 41% diabetics, and 11% current smokers). We discounted costs and effects at 3% per annum, and we assumed a willingness-to-pay threshold of $100,000 per QALY gained.

Projected ICERs were lowest ($13,326 per QALY) for the youngest cohort at baseline SBP of 155 mmHg and assumed effect size of 13 mmHg. The highest projected ICER ($263,417 per QALY) was found in the oldest age group at baseline SBP of 165 mmHg and assumed minimum effect size of 3 mmHg. Across all three age groups and baseline SBP levels, RDN was found to be cost-effective at effect sizes of 6 mmHg or higher.

Conclusions. Our model-based projections suggest RDN might be a cost-effective treatment strategy for effect sizes as low as –6 mmHg across a spectrum of age and baseline SBPs. The cost-effectiveness profile was gradually more favorable in patients of younger treatment age.