Cost-effectiveness of renal denervation therapy for the treatment of resistant hypertension in The Netherlands

Abstract

Objectives:

Safety and efficacy data for catheter-based renal denervation (RDN) in the treatment of resistant hypertension have been used to estimate the cost-effectiveness of this approach. However, there are no Dutch-specific analyses. This study examined the cost-effectiveness of RDN from the perspective of the healthcare payer in The Netherlands.

Methods:

A previously constructed Markov state-transition model was adapted and updated with costs and utilities relevant to the Dutch setting. The cost-effectiveness of RDN was compared with standard of care (SoC) for patients with resistant hypertension. The efficacy of RDN treatment was modeled as a reduction in the risk of cardiovascular events associated with a lower systolic blood pressure (SBP).

Results:

Treatment with RDN compared to SoC gave an incremental quality-adjusted life year (QALY) gain of 0.89 at an additional cost of €1315 over a patient’s lifetime, resulting in a base case incremental cost-effectiveness ratio (ICER) of €1474. Deterministic and probabilistic sensitivity analyses (PSA) showed that treatment with RDN therapy was cost-effective at conventional willingness-to-pay thresholds (€10,000–80,000/QALY).

Conclusion:

RDN is a cost-effective intervention for patients with resistant hypertension in The Netherlands.

• Cost-effectiveness
• Resistant hypertension
• Renal sympathetic denervation
• Prevention
• Cardiovascular disease

Transparency

Declaration of funding

The development of the economic model and manuscript was funded by Medtronic Ltd.

Declaration of financial/other relationships

TH & MVK are employees of BresMed Health Solutions, which was reimbursed by Medtronic Ltd as a consultancy for developing the Dutch renal denervation (RDN) model and preparing the manuscript. BDB is an employee of Medtronic Trading NL BV. PB has received grants from The Netherlands Organisation of Health and Research Development (ZonMw), the Dutch Kidney Foundation, and Medtronic Ltd. for RDN-related research. He received speakers and consultancy fees from Medtronic, St Jude and Johnson & Johnson. MB has received grants from Medtronic ltd. and The Netherlands Organisation for Health Research and Development (ZonMw) for the SYMPATHY trial for RDN. The Dutch Kidney Foundation also provided a grant for the renal denervation registry at University Medical Center Utrecht. JME Peer Reviewers on this manuscript have no relevant financial relationships to disclose.