title: InnovaSEC in Action: Cost-effectiveness of Barostim in the Treatment of Refractory Hypertension in Spain.
abstract: OBJECTIVE
  In Spain, 0.3% of patients with hypertension are refractory to conventional treatment. The complications resulting from deficient control of this condition can lead to poor quality of life for the patient and considerable health care costs. Barostim is an implantable device designed to lower blood pressure in these patients. The aim of this study was to analyze the cost-effectiveness of Barostim compared with drug therapy in hypertensive patients refractory to conventional treatment (at least 3 antihypertensive drugs, including 1 diuretic agent).
  
  
  METHODS
  We used a Markov model adapted to the epidemiology of the Spanish population to simulate the natural history of a cohort of patients with refractory hypertension over their lifetime. Data on the effectiveness of the treatments studied were obtained from the literature, and data on costs were taken from hospital administrative databases and official sources. Deterministic and probabilistic sensitivity analyses were conducted.
  
  
  RESULTS
  Barostim increased the number of quality-adjusted life years by 0.78 and reduced the number of hypertension-associated clinical events. The incremental cost-effectiveness ratio in a cohort of men reached 68 726 euros per year of quality-adjusted life. One of the main elements that makes this technology costly is the need for battery replacement. The results were robust.
  
  
  CONCLUSIONS
  Barostim is not a cost-effective strategy for the treatment of refractory hypertension in Spain. The cost-effectiveness ratio could be improved by future reductions in the cost of the battery.
authors.affiliation: Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain. Electronic address: soto@clinic.ub.es.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Soto
authors.affiliation: Unidad de Evaluación de Innovaciones y Nuevas Tecnologías, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Sampietro-Colom
authors.affiliation: Institut Clínic del Tòrax (ICT), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Sagarra
authors.affiliation: Institut Clínic del Tòrax (ICT), Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Brugada-Terradellas
mesh_terms: D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D017704:Baroreflex; D003362:Cost-Benefit Analysis; D004599:Electric Stimulation Therapy / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D004864:Equipment and Supplies / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D006973:Hypertension / Q000191:economics* / Q000628:therapy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D013030:Spain
chemical_list: D000959:Antihypertensive Agents
keywords: Accidente cerebrovascular; Cerebrovascular accident; Cost-effectiveness; Coste-efectividad; Hipertensión refractaria; Infarto de miocardio; Myocardial infarction; Refractory hypertension