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Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Cost-Effectiveness of Radiofrequency Renal Denervation for Resistant Hypertension in Australia
Markus P Schlaich1, Anne M Ryschon2, Sharad Shetty3
1Dobney Hypertension Centre, Medical School, Royal Perth Hospital Unit and RPH Research Foundation, University of Western Australia, Perth, WA, Australia; Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia; Department of Nephrology, Royal Perth Hospital, Perth, WA, Australia.
Aim:
Radiofrequency renal denervation (RF RDN) is a guideline-recommended, minimally invasive therapy for patients with uncontrolled, including resistant, hypertension. This analysis assesses the cost-effectiveness of RF RDN compared with optimal medical management for treatment of resistant hypertension in the Australian health care setting on the basis of contemporary clinical data.
Method:
A previously published and validated decision-analytic Markov model was adapted to the Australian health care setting. Primary health states modelled included hypertension, myocardial infarction, stroke, heart failure), angina pectoris/coronary artery disease, end-stage renal disease, and all-cause mortality, with transitions among health states informed by multivariate risk equations. Costs (reported in 2025 Australian Dollar [AUD]$) and utilities were sourced from fee schedules and published literature. The base case modelled a resistant hypertension cohort, informed by registry data, in whom treatment with RF RDN reduced office systolic blood pressure by -5.2 mmHg, based on sham-adjusted results from the SPYRAL HTN-ON MED randomised controlled trial. The primary outcomes included 5-year clinical event rates, in addition to strategy-specific costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio over lifetime. Cost-effectiveness was assessed against an assumed willingness-to-pay threshold of AUD$50,000 per QALY gained. Costs and effects were discounted 5% per annum in accordance with Australian cost-effectiveness guidelines. Extensive scenario and sensitivity analyses were conducted.
Results:
At 5 years, RF RDN yielded meaningful reductions in clinical events (relative risks of 0.80 for stroke, 0.88 for myocardial infarction, and 0.71 for heart failure). Under the base-case assumptions, RF RDN was associated with incremental costs of AUD$10,396 and QALYs of 0.28, producing a lifetime incremental cost-effectiveness ratio of AUD$36,655 per QALY gained. RF RDN was shown to be cost-effective across the range of scenario and sensitivity analyses explored.
Conclusions:
Blood pressure reductions observed with RF RDN are projected to lead to meaningful clinical event reductions that render the therapy a cost-effective adjunctive treatment option for patients with resistant hypertension in Australia.
