Renal denervation (RDN) for resistant hypertension may be cost-effective and may provide long-term clinical benefits, according to a new analysis published in the Journal of the American College of Cardiology.
Benjamin Geisler and colleagues developed a model to predict the impact of the Medtronic Symplicity RDN system in patients with resistant hypertension. Over 10 years, according to the model, RDN treatment resulted in large differences in outcomes, though the benefits were less pronounced when projected over a lifetime.
Projected 10 year Relative Risk:
- Stroke: 0.70 (reduced from 11.6% in the control group to 8.2% in the RDN group)
- MI: 0.68 (reduced from 9.6% to 6.5%)
- CHD: 0.78 (reduced from 24.8% to 19.4%)
- HF: 0.79 (reduced from 5.4% to 4.3%)
- ESRD: 0.72 (reduced from 2.9% to 2.1%
- CV mortality: 0.70 (reduced from 12.5% to 8.7%)
- All-cause mortality: 0.85 (reduced from 23.0% to 19.5%)
Median survival was lengthened from 17.07 years to 18.37 years. The authors calculated an increase in quality-adjusted life-years (QALY) from 12.07 to 13.17 years, resulting in a discounted incremental cost-effectiveness ratio of $3,071/QALY. Cost-effectiveness was “markedly below the commonly accepted threshold of $50,000 per QALY [quality-adjusted life-year],” and might even be cost-saving, according to the authors.
The model assumes that RDN causes a long term reduction in blood pressure, though current data from the Symplicity HTN-2 trial only extends to 36 months. However, the authors reported that RDN remained “cost-effective across a wide range of assumptions.”
Republished with permission from CardioExchange, a NEJM group publication.