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Cost Effectiveness of Endovascular Ultrasound Renal Denervation in Patients with Resistant Hypertension

Author

Listed:
  • Rod S. Taylor

    (University of Glasgow)

  • Anthony Bentley

    (Mtech Access Limited)

  • Kaylie Metcalfe

    (Mtech Access Limited)

  • Melvin D. Lobo

    (Queen Mary University of London)

  • Ajay J. Kirtane

    (Columbia University Irving Medical Center/New York-Presbyterian Hospital and the Cardiovascular Research Foundation)

  • Michel Azizi

    (Université de Paris
    Hôpital Européen Georges-Pompidou
    INSERM, CIC1418)

  • Christopher Clark

    (University of Exeter Medical School)

  • Kieran Murphy

    (ReCor Medical)

  • Jennifer H. Boer

    (BresMed Netherlands)

  • Marjolijn Keep

    (BresMed Netherlands)

  • An Thu Ta

    (BresMed Netherlands)

  • Neil C. Barman

    (ReCor Medical)

  • Garrett Schwab

    (ReCor Medical)

  • Ron Akehurst

    (BresMed Health Solutions
    University of Sheffield)

  • Roland E. Schmieder

    (Friedrich Alexander University)

Abstract

Background Resistant hypertension (rHTN) is defined as blood pressure (BP) of ≥ 140/90 mmHg despite treatment with at least three antihypertensive medications, including a diuretic. Endovascular ultrasound renal denervation (uRDN) aims to control BP alongside conventional BP treatment with antihypertensive medication. This analysis assesses the cost effectiveness of the addition of the Paradise uRDN System compared with standard of care alone in patients with rHTN from the perspective of the United Kingdom (UK) health care system. Methods Using RADIANCE-HTN TRIO trial data, we developed a state-transition model. Baseline risk was calculated using Framingham and Prospective Cardiovascular Münster (PROCAM) risk equations to estimate the long-term cardiovascular risks in patients treated with the Paradise uRDN System, based on the observed systolic BP (SBP) reduction following uRDN. Relative risks sourced from a meta-analysis of randomised controlled trials were then used to project cardiovascular events in patients with baseline SBP (‘control’ patients); utility and mortality inputs and costs were derived from UK data. Costs and outcomes were discounted at 3.5% per annum. Modelled outcomes were validated against trial meta-analyses and the QRISK3 algorithm and real-world evidence of RDN effectiveness. One-way and probabilistic sensitivity analyses were conducted to assess the uncertainty surrounding the model inputs and sensitivity of the model results to changes in parameter inputs. Results were reported as incremental cost-effectiveness ratios (ICERs). Results A mean reduction in office SBP of 8.5 mmHg with uRDN resulted in an average improvement in both absolute life-years (LYs) and quality-adjusted life-years (QALYs) gained compared with standard of care alone (0.73 LYs and 0.67 QALYs). The overall base-case ICER with uRDN was estimated at £5600 (€6500) per QALY gained (95% confidence interval £5463–£5739 [€6341–€6661]); modelling demonstrated > 99% probability that the ICER is below the £20,000–£30,000 (€23,214–€34,821) per QALYs gained willingness-to-pay threshold in the UK. Results were consistent across sensitivity analyses and validation checks. Conclusions Endovascular ultrasound RDN with the Paradise system offers patients with rHTN, clinicians, and healthcare systems a cost-effective treatment option alongside antihypertensive medication.

Suggested Citation

  • Rod S. Taylor & Anthony Bentley & Kaylie Metcalfe & Melvin D. Lobo & Ajay J. Kirtane & Michel Azizi & Christopher Clark & Kieran Murphy & Jennifer H. Boer & Marjolijn Keep & An Thu Ta & Neil C. Barman, 2024. "Cost Effectiveness of Endovascular Ultrasound Renal Denervation in Patients with Resistant Hypertension," PharmacoEconomics - Open, Springer, vol. 8(4), pages 525-537, July.
    • Handle: RePEc:spr:pharmo:v:8:y:2024:i:4:d:10.1007_s41669-024-00472-z
    DOI: 10.1007/s41669-024-00472-z
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    References listed on IDEAS

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    1. Daniel Polsky & Henry A. Glick & Richard Willke & Kevin Schulman, 1997. "Confidence Intervals for Cost–Effectiveness Ratios: A Comparison of Four Methods," Health Economics, John Wiley & Sons, Ltd., vol. 6(3), pages 243-252, May.
    2. Don Husereau & Michael Drummond & Stavros Petrou & Chris Carswell & David Moher & Dan Greenberg & Federico Augustovski & Andrew Briggs & Josephine Mauskopf & Elizabeth Loder, 2013. "Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement," PharmacoEconomics, Springer, vol. 31(5), pages 361-367, May.
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