title: Potential lifetime cost-effectiveness of catheter-based renal sympathetic denervation in patients with resistant hypertension.
abstract: OBJECTIVE
  Recent studies have demonstrated the safety and efficacy of catheter-based renal sympathetic denervation (RDN) for the treatment of resistant hypertension. We aimed to determine the cost-effectiveness of this approach separately for men and women of different ages.
  
  
  RESULTS
  A Markov state-transition model accounting for costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness was developed to compare RDN with best medical therapy (BMT) in patients with resistant hypertension. The model ran from age 30 to 100 years or death, with a cycle length of 1 year. The efficacy of RDN was modelled as a reduction in the risk of hypertension-related disease events and death. Analyses were conducted from a payer's perspective. Costs and QALYs were discounted at 3% annually. Both deterministic and probabilistic sensitivity analyses were performed. When compared with BMT, RDN gained 0.98 QALYs in men and 0.88 QALYs in women 60 years of age at an additional cost of €2589 and €2044, respectively. As the incremental cost-effectiveness ratios increased with patient age, RDN consistently yielded more QALYs at lower costs in lower age groups. Considering a willingness-to-pay threshold of €35 000/QALY, there was a 95% probability that RDN would remain cost-effective up to an age of 78 and 76 years in men and women, respectively. Cost-effectiveness was influenced mostly by the magnitude of effect of RDN on systolic blood pressure, the rate of RDN non-responders, and the procedure costs of RDN.
  
  
  CONCLUSIONS
  Renal sympathetic denervation is a cost-effective intervention for patients with resistant hypertension. Earlier treatment produces better cost-effectiveness ratios.
authors.affiliation: Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. marc.dorenkamp@charite.de
authors.forename: Marc
authors.initials: M
authors.lastname: Dorenkamp
authors.forename: Klaus
authors.initials: K
authors.lastname: Bonaventura
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Leber
authors.forename: Julia
authors.initials: J
authors.lastname: Boldt
authors.forename: Christian
authors.initials: C
authors.lastname: Sohns
authors.forename: Leif-Hendrik
authors.initials: LH
authors.lastname: Boldt
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Haverkamp
authors.forename: Ulrich
authors.initials: U
authors.lastname: Frei
authors.forename: Mattias
authors.initials: M
authors.lastname: Roser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000191:economics / Q000209:etiology; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D006973:Hypertension / Q000191:economics / Q000601:surgery*; D007668:Kidney / Q000294:innervation; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013562:Sympathectomy / Q000191:economics*; D014546:Urinary Catheterization / Q000191:economics