Cost-Utility Analysis of Endovascular Ultrasound Renal Denervation to Treat Resistant Hypertension in the United States

Abstract

Background

This study evaluated the cost utility of ultrasound renal denervation (uRDN) for resistant hypertension in the United States.

Methods

A previously published Markov model was adapted to compare total costs and quality-adjusted life years (QALY) between uRDN plus standard of care (SoC) vs SoC alone over a lifetime horizon from a US health care system perspective. Patient characteristics and clinical inputs were drawn from the RADIANCE-HTN TRIO trial, and the incidence of key cardiovascular events was estimated using published risk equations. Utility values and US health care cost inputs were based on a targeted literature review. Incremental cost-effectiveness ratio was evaluated against standard cost-effectiveness thresholds ranging from $50,000 to $100,000 per QALY. Scenario, deterministic, and probabilistic sensitivity analyses were used to assess the robustness of findings. All costs and QALY were discounted at 3% per year.

Results

In the base case analysis, an 8.5 mm Hg reduction in systolic blood pressure with uRDN compared with SoC alone resulted in lower relative risks of cardiovascular events and additional life years (15.00 vs 14.29) and QALY (12.01 vs 11.42). Using a procedure cost of $23,000, total lifetime costs were higher with the uRDN procedure (uRDN plus SoC: $110,476 vs SoC alone: $102,875), resulting in an incremental cost-effectiveness ratio of $12,900 per QALY. Sensitivity and scenario analyses demonstrate that the findings were robust to changes in key model inputs including a systolic blood pressure reduction with uRDN from –5.0 to –9.6 mm Hg.

Conclusions

Evaluated against conventional cost-effectiveness thresholds in the US, the addition of uRDN is estimated to offer a cost-effective approach alongside lifestyle modification and antihypertensive medications for patients with resistant hypertension.