Cost-Effectiveness of Ultrasound Renal Denervation for Resistant Hypertension in Belgium, France and The Netherlands.

Abstract

Background: Endovascular ultrasound renal denervation (uRDN) with the Paradise System has emerged as an adjunctive treatment option for the management of uncontrolled resistant hypertension (rHTN). This study assesses the cost-effectiveness of uRDN for rHTN across three European countries-Belgium, France and the Netherlands.

Methods: On the basis of a previously developed state-transition Markov model, we projected costs, life years (LYs) and quality adjusted life years (QALYs) with the addition of uRDN to standard of care (SoC) compared with SoC alone over patient lifetime. Analyses were based on the RADIANCE-HTN TRIO trial, which demonstrated a mean reduction in office systolic blood pressure from a baseline of 8.5 mmHg at 2 months post-uRDN among patients with rHTN. Mortality and costs data were separately sourced and applied for each country independently. Country-specific discount rates were applied to both cost and outcomes. One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty surrounding the model inputs and sensitivity of the model results to changes in parameter inputs. Results were reported as incremental cost-effectiveness ratios (ICERs).

Results: The base-case analyses of the models for all three countries show uRDN plus SoC results in improvement in both LYs and QALYs per patient and higher costs compared with SoC alone. The mean ICERs for each country model fall well below the respective country-specific willingness-to-pay thresholds (WTPs)-Belgium: WTP €40,000 and ICER €4426/QALY gained; France: WTP €50,000 and ICER €6261/QALY gained; and the Netherlands: WTP €20,000 and ICER €1654/QALY gained. Results were robust across scenarios and sensitivity analyses.

Conclusions: The addition of endovascular uRDN offers clinicians and payers a cost-effective adjunctive treatment approach alongside hypertensive medication for the management of rHTN in the healthcare systems of Belgium, France and the Netherlands.