title: Cost-effectiveness of treating resistant hypertension with an implantable carotid body stimulator.
abstract: The purposes of this study are to investigate the cost-effectiveness of an implantable carotid body stimulator (Rheos; CVRx, Inc, Minneapolis, MN) for treating resistant hypertension and determine the range of starting systolic blood pressure (SBP) values where the device remains cost-effective. A Markov model compared a 20-mm Hg drop in SBP from an initial level of 180 mm Hg with Rheos to failed medical management in a hypothetical 50-year-old cohort. Direct costs (2007$), utilities, and event rates for future myocardial infarction, stroke, heart failure, and end-stage renal disease were modeled. Sensitivity analyses tested the assumptions in the model. The incremental cost-effectiveness ratio (ICER) for Rheos was $64,400 per quality-adjusted life-years (QALYs) using Framingham-derived event probabilities. The ICER was <$100,000 per QALYs for SBPs > or =142 mm Hg. A probability of device removal of <1% per year or SBP reductions of > or =24 mm Hg were variables that decreased the ICER below $50,000 per QALY. For cohort characteristics similar to Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure-Lowering Arm (ASCOT-BPLA) participants, the ICER became $26,700 per QALY. Two-way sensitivity analyses demonstrated that lowering SBP 12 mm Hg from 220 mm Hg or 21 mm Hg from 140 mm Hg were required. Rheos may be cost-effective, with an ICER between $50,000 and $100,000 per QALYs. Cohort characteristics and efficacy are key to the cost-effectiveness of new therapies for resistant hypertension .
authors.affiliation: Department of Surgery, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14620, USA. kate_young@urmc.rochester.edu
authors.forename: Kate C
authors.initials: KC
authors.lastname: Young
authors.forename: J C
authors.initials: JC
authors.lastname: Teeters
authors.forename: Curtis G
authors.initials: CG
authors.lastname: Benesch
authors.forename: John D
authors.initials: JD
authors.lastname: Bisognano
authors.forename: Karl A
authors.initials: KA
authors.lastname: Illig
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000191:economics / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology*; D002344:Carotid Body / Q000502:physiology*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004351:Drug Resistance / Q000502:physiology; D004599:Electric Stimulation Therapy / Q000191:economics* / Q000295:instrumentation* / Q000379:methods; D004567:Electrodes, Implanted; D005650:Fumarates / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000503:physiopathology* / Q000628:therapy*; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D000577:Amides; D000959:Antihypertensive Agents; D005650:Fumarates; C446481:aliskiren