title: Cost-effectiveness and clinical effectiveness of catheter-based renal denervation for resistant hypertension.
abstract: OBJECTIVE
  The purpose of this study was to assess cost-effectiveness and long-term clinical benefits of renal denervation in resistant hypertensive patients.
  
  
  BACKGROUND
  Resistant hypertension affects 12% of hypertensive persons. In the Symplicity HTN-2 randomized controlled trial, catheter-based renal denervation (RDN) lowered systolic blood pressure by 32 ± 23 mm Hg from 178 ± 18 mm Hg at baseline.
  
  
  METHODS
  A state-transition model was used to predict the effect of RDN and standard of care on 10-year and lifetime probabilities of stroke, myocardial infarction, all coronary heart disease, heart failure, end-stage renal disease, and median survival. We adopted a societal perspective and estimated an incremental cost-effectiveness ratio in U.S. dollars per quality-adjusted life-year, both discounted at 3% per year. Robustness and uncertainty were evaluated using deterministic and probabilistic sensitivity analyses.
  
  
  RESULTS
  Renal denervation substantially reduced event probabilities (10-year/lifetime relative risks: stroke 0.70/0.83; myocardial infarction 0.68/0.85; all coronary heart disease 0.78/0.90; heart failure 0.79/0.92; end-stage renal disease 0.72/0.81). Median survival was 18.4 years for RDN versus 17.1 years for standard of care. The discounted lifetime incremental cost-effectiveness ratio was $3,071 per quality-adjusted life-year. Findings were relatively insensitive to variations in input parameters except for systolic blood pressure reduction, baseline systolic blood pressure, and effect duration. The 95% credible interval for incremental cost-effectiveness ratio was cost-saving to $31,460 per quality-adjusted life-year.
  
  
  CONCLUSIONS
  The model suggests that catheter-based renal denervation, over a wide range of assumptions, is a cost-effective strategy for resistant hypertension that might result in lower cardiovascular morbidity and mortality.
authors.affiliation: Wing Tech Inc., Menlo Park, California, USA.
authors.forename: Benjamin P
authors.initials: BP
authors.lastname: Geisler
authors.forename: Brent M
authors.initials: BM
authors.lastname: Egan
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Cohen
authors.forename: Abigail M
authors.initials: AM
authors.lastname: Garner
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Akehurst
authors.forename: Murray D
authors.initials: MD
authors.lastname: Esler
authors.forename: Jan B
authors.initials: JB
authors.lastname: Pietzsch
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality; D002404:Catheterization; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D006973:Hypertension / Q000191:economics* / Q000601:surgery*; D007668:Kidney / Q000294:innervation*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D015203:Reproducibility of Results; D012306:Risk; D013562:Sympathectomy / Q000191:economics*; D016896:Treatment Outcome