Radiofrequency renal denervation cost-effective for uncontrolled hypertension
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Key takeaways:
- Radiofrequency renal denervation is estimated to be a cost-effective treatment for uncontrolled hypertension.
- The intervention was projected to reduce risk for stroke, MI and HF across a patient’s lifetime.
Researchers reported that radiofrequency renal denervation is estimated to be cost-effective for uncontrolled hypertension despite multiple antihypertensive medications, at 13,482 British pounds per quality-adjusted life-years gained.
“Since its introduction, radiofrequency renal denervation has been refined to deliver radiofrequency energy simultaneously to all four renal artery quadrants, reducing procedural time and potentially improving efficacy,” Andrew S.P. Sharp, MBChB, MD, professor of cardiology and consultant cardiologist at University Hospital of Wales and Cardiff University in Cardiff, U.K., and colleagues wrote. “The cost-effectiveness of renal denervation for resistant hypertension has previously been reported based on the results of the open-label Symplicity HTN-2 trial using the first-generation Symplicity Flex catheter. The current study sought to expand upon these analyses to determine the cost-effectiveness of radiofrequency renal denervation for the treatment of the broader uncontrolled hypertension patient group reflecting contemporary data and evidence from the new generation of clinical studies that utilized different trials designs and procedural technologies/techniques.”
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For the base case analysis, Sharp and colleagues chose the SPYRAL HTN-ON MED trial because it is the largest randomized sham-controlled trial for the current generation of radiofrequency renal denervation devices (Symplicity Spyral, Medtronic) in patients with uncontrolled hypertension on up to three antihypertensive medications.
As Healio previously reported, radiofrequency renal denervation lowered BP in patients with resistant hypertension already on antihypertensive medication, lowering office systolic BP by 4.9 mm Hg compared with sham (P = .001), but did not meet its primary efficacy endpoint.
Using this data, the researchers conducted a decision-analytic model based on multivariate risk equations to project adverse events, QALYs and costs.
Their findings were published in European Heart Journal – Quality of Care and Clinical Outcomes.
Costs were based on National Health Services (NHS) data, and the incremental cost-effectiveness ratio (ICER) was evaluated against the U.K. National Institute for Health and Care Excellence threshold of 20,000 pounds to 30,000 pounds per QALY gained.
The researchers reported that radiofrequency renal denervation was associated with a 10-year RR reduction of 0.8 for stroke, 0.88 for MI and 0.72 for HF, with benefit projected over a patient’s lifetime.
Radiofrequency denervation was estimated to add an additional 0.35 QALYs at a cost of 4,763 pounds, translating to an ICER of 13,482 pounds per QALY gained, according to the study.
“The analysis found that an effect size of 4.9 mm Hg, as observed in the SPYRAL HTN-ON MED study, can be expected to lead to meaningful outcome improvement and related downstream cost savings in the long term, which render the intervention good value for money,” the researchers wrote. “Specifically, a significant reduction of 20% for stroke and 12% for MI was found for a 10-year horizon in treated vs. control subjects, indicating the potential for radiofrequency renal denervation to reduce or delay major hypertension sequelae. Radiofrequency renal denervation had a favorable cost-effectiveness profile across different studies, and a broad range of patient demographics and baseline systolic BPs, signaling potential therapeutic benefit and cost-effectiveness for a large proportion of the hypertensive population.”
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Sharp ASP, et al. Eur Heart J Qual Care Clin Outcomes. 2024;doi:10.1093/ehjqcco/qcae001/7513764.
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