Cost-effectiveness analysis of radiofrequency renal denervation for uncontrolled hypertension in Canada.

Abstract

Aims: Catheter-based radiofrequency renal denervation (RF RDN) is an interventional treatment for uncontrolled hypertension. This analysis explored the therapy's lifetime cost-effectiveness in a Canadian healthcare setting.

Materials and methods: A decision-analytic Markov model was used to project health events, costs, and quality-adjusted life years over a lifetime horizon. Seven primary health states were modeled, including hypertension alone, stroke, myocardial infarction (MI), other symptomatic coronary artery disease, heart failure (HF), end-stage renal disease (ESRD), and death. Multivariate risk equations and a meta-regression of hypertension trials informed transition probabilities. Contemporary clinical evidence from the SPYRAL HTN-ON MED trial informed the base case treatment effect (-4.9 mmHg change in office systolic blood pressure (oSBP) observed vs. sham control). Costs were sourced from published literature. A 1.5% discount rate was applied to costs and effects, and the resulting incremental cost-effectiveness ratio (ICER) was evaluated against a willingness-to-pay threshold of $50,000 per QALY gained. Extensive scenario and sensitivity analyses were performed.

Results: Over 10 years, RF RDN resulted in relative risk reduction in clinical events (0.80 for stroke, 0.88 for MI, and 0.72 for HF). Under the base case assumptions, RF RDN was found to add 0.51 (15.81 vs. 15.30) QALYs at an incremental cost of $6,031 ($73,971 vs. $67,040) over a lifetime, resulting in an ICER of $11,809 per QALY gained. Cost-effectiveness findings were found robust in sensitivity analyses, with the 95% confidence interval for the ICER based on 10,000 simulations ranging from $4,489 to $22,587 per QALY gained.

Limitations and conclusion: Model projections suggest RF RDN, under assumed maintained treatment effect, is a cost-effective treatment strategy for uncontrolled hypertension in the Canadian healthcare system based on meaningful reductions in clinical events.