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Cost Effectiveness of Renal Denervation Therapy for the Treatment of Resistant Hypertension in the UK

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Abstract

Background

Patients with resistant hypertension are at a high risk for developing serious cardiovascular events and renal complications. Catheter-based renal denervation (RDN) is a procedure with the potential to normalize systolic blood pressure (SBP).

Objective

The overall objective of the study was to estimate the cost effectiveness of RDN in the UK for patients with diagnosed resistant hypertension, expressed as a standard cost per quality-adjusted life-year (QALY) ratio.

Methods

A patient lifetime, economic, Markov heath-state model was developed, linking expected changes in SBP to reductions in risks for cardiovascular events and renal complications, using the Framingham, PROCAM, and other published risk equations. The model was developed from the perspective of the healthcare payer in the UK using relevant cost data from 2012. Clinical effectiveness for RDN (a mean reduction of 32 mmHg in SBP) was taken from the phase III Symplicity HTN-2 trial, in patients with a mean baseline SBP of 178 mmHg. HTN-2 was the largest, multicenter randomized controlled trial on the effectiveness of RDN therapy at the time of the model development. A systematic review identified UK-specific sources for utility, mortality, and cost parameter values, and included recently published UK guidelines for the clinical management of hypertension.

Results

RDN therapy resulted in an increase in health benefit over a patient’s lifetime compared with anti-hypertensive pharmacological treatment alone (12.77 vs. 12.16 QALYs; discounted). Additional lifetime costs per patient were modeled at £2,961; equivalent to an incremental cost per additional QALY of £4,805. This result was robust to full probabilistic sensitivity and scenario analyses.

Conclusion

RDN is an effective clinical procedure that offers patients a meaningful and cost-effective alternative for achieving SBP control, where traditional combination, anti-hypertensive pharmacologic strategies have been proven to be ineffective.

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Acknowledgments

Funding was provided by Medtronic Ltd.

Conflict of interest

DG, TH, and RA are employees of BresMed Health Solutions, which was reimbursed by Medtronic Ltd as a consultancy for developing the UK RDN model and preparing the manuscript. They have no other competing interests in this study. MC is an employee of Medtronic Ltd.

Author’s contributions

DG (guarantor) and TH led the model design and construction, and developed the cost-effectiveness analyses. RA provided conceptual design for the model and co-authored the manuscript. MC co-authored the manuscript and provided the clinical input and direction for the modeling. All authors have read and agreed to the content of this publication.

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Authors and Affiliations

  1. BresMed Health Solutions, North Church House, Queen Street, Sheffield, S1 2DW, England

    Daniel Gladwell & Thea Henry

  2. Medtronic Ltd, Croxley Green Business Park, Watford, WD18 8WW, England

    Mark Cook

  3. Hon MFPHM, BresMed Health Solutions, North Church House, Sheffield, S1 2DW, England

    Ron Akehurst

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  1. Daniel Gladwell
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Corresponding author

Correspondence to Thea Henry.

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Gladwell, D., Henry, T., Cook, M. et al. Cost Effectiveness of Renal Denervation Therapy for the Treatment of Resistant Hypertension in the UK. Appl Health Econ Health Policy 12, 611–622 (2014). https://doi.org/10.1007/s40258-014-0116-7

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