Cost-effectiveness of renal denervation therapy for treatment-resistant hypertension

A best case scenario

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

BACKGROUND Renal denervation (RDN) is effective at reducing blood pressure (BP) among patients with treatment-resistant hypertension (TRH). However, recent findings regarding the effectiveness of RDN for BP reduction compared with standard treatment of care (SoC) has initiated a rigorous debate about its role in TRH management. In this study, we sought to determine the thresholds for cardiovascular risk and costs of RDN which would make RDN cost-effective. METHODS A Markov model was constructed to simulate cardiovascular events over a lifetime among TRH subjects aged 60 years at baseline, and without prior cardiovascular disease. The effect on lowering BP was based on results observed in clinical trials of RDN undertaken to date, and the expected subsequent change to cardiovascular risk was drawn from a published meta-regression. Cost and utility data were drawn from published sources. Incremental cost-effectiveness ratios (ICER) in terms of Australian dollars (AUD) per life year and per quality-adjusted life year (QALY) gained were estimated to assess RDN cost-effectiveness relative to SoC from the Australian health care perspective, assuming a willingness-to-pay threshold of AUD 50,000. RESULTS Over a lifetime horizon, the model predicted that at the current estimated costs of RDN (AUD 9531/€6573, 1€ = 1.45 AUD), it would be cost-effective only if it was targeted to patients whose 10-year predicted cardiovascular risk was at least 13.2% initially. The ICERs (discounted) were AUD 49,519 per life year gained and AUD 47,130 per QALY gained. CONCLUSIONS At current costs and based on currently observed effects on BP reduction, RDN would be cost-effective among patients with TRH.

Original languageEnglish
Pages (from-to)1156-1163
Number of pages8
JournalAmerican Journal of Hypertension
Volume31
Issue number10
DOIs
Publication statusPublished - Oct 2018

Keywords

  • blood pressure
  • cardiovascular disease
  • cost-effective
  • hypertension
  • renal denervation
  • treatment-resistant hypertension

Cite this

@article{c8ab164f923e461b94f631117680df5e,
title = "Cost-effectiveness of renal denervation therapy for treatment-resistant hypertension: A best case scenario",
abstract = "BACKGROUND Renal denervation (RDN) is effective at reducing blood pressure (BP) among patients with treatment-resistant hypertension (TRH). However, recent findings regarding the effectiveness of RDN for BP reduction compared with standard treatment of care (SoC) has initiated a rigorous debate about its role in TRH management. In this study, we sought to determine the thresholds for cardiovascular risk and costs of RDN which would make RDN cost-effective. METHODS A Markov model was constructed to simulate cardiovascular events over a lifetime among TRH subjects aged 60 years at baseline, and without prior cardiovascular disease. The effect on lowering BP was based on results observed in clinical trials of RDN undertaken to date, and the expected subsequent change to cardiovascular risk was drawn from a published meta-regression. Cost and utility data were drawn from published sources. Incremental cost-effectiveness ratios (ICER) in terms of Australian dollars (AUD) per life year and per quality-adjusted life year (QALY) gained were estimated to assess RDN cost-effectiveness relative to SoC from the Australian health care perspective, assuming a willingness-to-pay threshold of AUD 50,000. RESULTS Over a lifetime horizon, the model predicted that at the current estimated costs of RDN (AUD 9531/€6573, 1€ = 1.45 AUD), it would be cost-effective only if it was targeted to patients whose 10-year predicted cardiovascular risk was at least 13.2{\%} initially. The ICERs (discounted) were AUD 49,519 per life year gained and AUD 47,130 per QALY gained. CONCLUSIONS At current costs and based on currently observed effects on BP reduction, RDN would be cost-effective among patients with TRH.",
keywords = "blood pressure, cardiovascular disease, cost-effective, hypertension, renal denervation, treatment-resistant hypertension",
author = "Chowdhury, {Enayet K.} and Reid, {Christopher M.} and Ella Zomer and Kelly, {Darren J.} and Danny Liew",
year = "2018",
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doi = "10.1093/ajh/hpy108",
language = "English",
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pages = "1156--1163",
journal = "American Journal of Hypertension",
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Cost-effectiveness of renal denervation therapy for treatment-resistant hypertension : A best case scenario. / Chowdhury, Enayet K.; Reid, Christopher M.; Zomer, Ella; Kelly, Darren J.; Liew, Danny.

In: American Journal of Hypertension, Vol. 31, No. 10, 10.2018, p. 1156-1163.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Cost-effectiveness of renal denervation therapy for treatment-resistant hypertension

T2 - A best case scenario

AU - Chowdhury, Enayet K.

AU - Reid, Christopher M.

AU - Zomer, Ella

AU - Kelly, Darren J.

AU - Liew, Danny

PY - 2018/10

Y1 - 2018/10

N2 - BACKGROUND Renal denervation (RDN) is effective at reducing blood pressure (BP) among patients with treatment-resistant hypertension (TRH). However, recent findings regarding the effectiveness of RDN for BP reduction compared with standard treatment of care (SoC) has initiated a rigorous debate about its role in TRH management. In this study, we sought to determine the thresholds for cardiovascular risk and costs of RDN which would make RDN cost-effective. METHODS A Markov model was constructed to simulate cardiovascular events over a lifetime among TRH subjects aged 60 years at baseline, and without prior cardiovascular disease. The effect on lowering BP was based on results observed in clinical trials of RDN undertaken to date, and the expected subsequent change to cardiovascular risk was drawn from a published meta-regression. Cost and utility data were drawn from published sources. Incremental cost-effectiveness ratios (ICER) in terms of Australian dollars (AUD) per life year and per quality-adjusted life year (QALY) gained were estimated to assess RDN cost-effectiveness relative to SoC from the Australian health care perspective, assuming a willingness-to-pay threshold of AUD 50,000. RESULTS Over a lifetime horizon, the model predicted that at the current estimated costs of RDN (AUD 9531/€6573, 1€ = 1.45 AUD), it would be cost-effective only if it was targeted to patients whose 10-year predicted cardiovascular risk was at least 13.2% initially. The ICERs (discounted) were AUD 49,519 per life year gained and AUD 47,130 per QALY gained. CONCLUSIONS At current costs and based on currently observed effects on BP reduction, RDN would be cost-effective among patients with TRH.

AB - BACKGROUND Renal denervation (RDN) is effective at reducing blood pressure (BP) among patients with treatment-resistant hypertension (TRH). However, recent findings regarding the effectiveness of RDN for BP reduction compared with standard treatment of care (SoC) has initiated a rigorous debate about its role in TRH management. In this study, we sought to determine the thresholds for cardiovascular risk and costs of RDN which would make RDN cost-effective. METHODS A Markov model was constructed to simulate cardiovascular events over a lifetime among TRH subjects aged 60 years at baseline, and without prior cardiovascular disease. The effect on lowering BP was based on results observed in clinical trials of RDN undertaken to date, and the expected subsequent change to cardiovascular risk was drawn from a published meta-regression. Cost and utility data were drawn from published sources. Incremental cost-effectiveness ratios (ICER) in terms of Australian dollars (AUD) per life year and per quality-adjusted life year (QALY) gained were estimated to assess RDN cost-effectiveness relative to SoC from the Australian health care perspective, assuming a willingness-to-pay threshold of AUD 50,000. RESULTS Over a lifetime horizon, the model predicted that at the current estimated costs of RDN (AUD 9531/€6573, 1€ = 1.45 AUD), it would be cost-effective only if it was targeted to patients whose 10-year predicted cardiovascular risk was at least 13.2% initially. The ICERs (discounted) were AUD 49,519 per life year gained and AUD 47,130 per QALY gained. CONCLUSIONS At current costs and based on currently observed effects on BP reduction, RDN would be cost-effective among patients with TRH.

KW - blood pressure

KW - cardiovascular disease

KW - cost-effective

KW - hypertension

KW - renal denervation

KW - treatment-resistant hypertension

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U2 - 10.1093/ajh/hpy108

DO - 10.1093/ajh/hpy108

M3 - Article

VL - 31

SP - 1156

EP - 1163

JO - American Journal of Hypertension

JF - American Journal of Hypertension

SN - 0895-7061

IS - 10

ER -