Cost-effectiveness of radiofrequency renal denervation for uncontrolled and resistant hypertension in The Netherlands

Radiofrequency renal denervation (RF RDN) has been recommended as an adjunct therapeutic option for uncontrolled including resistant hypertension. This analysis sought to evaluate the cost-effectiveness of RF RDN treatment in the Dutch healthcare setting.

A previously published decision-analytic model was utilised to project outcomes over a lifetime horizon for RF RDN vs. standard of care (SoC). Data from the SPYRAL HTN-ON MED study informed the cohort characteristics and base case treatment effect modelled (-4.9 mmHg office-based systolic blood pressure (oSBP) reduction vs. sham), while alternate assumptions were explored in sensitivity analyses. Cost-effectiveness was evaluated against a burden of disease-determined threshold of €20,000 per quality-adjusted life year gained, according to Dutch guidelines.

In the base case, ten-year clinical event risk reductions were 0.80 for stroke, 0.88 for myocardial infarction, 0.89 for angina pectoris and coronary heart disease, 0.72 for heart failure, 0.96 for end-stage renal disease, and 0.93 for all-cause death. Over lifetime and under the base case effect size, RF RDN resulted in increased costs of €4,137 (€46,769 (RF RDN) vs. €42,632 (SoC)) and quality-adjusted life years (QALY) of 0.61 (17.49 RF RDN vs. 16.88 SoC), with an incremental cost-effectiveness ratio (ICER) of €6,784 per QALY gained. RF RDN was highly cost-effective or dominant across the range of scenario and sensitivity analyses performed.

Over lifetime, RF RDN was found cost-effective in the Dutch healthcare system, with an ICER substantially below the applicable willingness-to-pay threshold, while providing meaningful reductions in clinical events for uncontrolled including resistant hypertension patients.