A Cost-Effectiveness Analysis of Radiofrequency Renal Denervation for Uncontrolled Hypertension Based on the SPYRAL HTN-ON Med Trial in the Netherlands

OBJECTIVES: Radiofrequency renal denervation (RF RDN) is increasingly recognized as an adjunct therapy option for uncontrolled hypertension, including resistant hypertension. This study sought to assess the cost-effectiveness of RF RDN in the Dutch healthcare setting.

METHODS: Clinical events, quality-adjusted survival, and costs at a ten-year and lifetime horizon were projected with a previously published and validated Markov model based on multivariate risk equations, including the Framingham equations. Risk reductions from changes in office-based systolic blood pressure (oSBP) were based on a meta-regression of 47 hypertension randomized-controlled trials (RCTs). The base case -4.9 mmHg oSBP reduction in the treatment group obtained from the SPYRAL HTN-ON MED full cohort study, in which both groups maintained use of antihypertensive medication. The relative risks (RR) of clinical events at ten years were projected for stroke, myocardial infarction (MI), angina pectoris/coronary heart disease (AP/CHD), heart failure (HF), end-stage renal disease (ESRD), cardiovascular death (CVD) and all-cause death (ACD). The lifetime incremental cost-effectiveness ratio (ICER) was examined against a Dutch burden of disease-derived willingness-to-pay threshold of €20,000 per quality-adjusted life-year (QALY) gained, with costs and effects discounted 3.0% and 1.5%, respectively, per Dutch guidelines.

RESULTS: RF RDN led to a RR and absolute risk reduction (ARR) in clinical events (0.80 and 1.7% for stroke, 0.88 and 0.9% for MI, 0.89 and 1.6% for AP/CHD, 0.72 and 1.4% for HF, 0.96 and 0.014% for ESRD, 0.86 and 1.0% for CVD, and 0.93 and 0.9% for ACS, respectively). Over a lifetime horizon, the therapy added 0.61 QALYs with an incremental cost of €3,828, yielding an ICER of €6,277 per QALY gained, below the willingness-to-pay threshold of €20,000 per QALY gained.

CONCLUSIONS: Findings from this analysis suggest RF RDN adds meaningful clinical benefit at incremental cost that render it a cost-effective intervention in the Dutch healthcare system.