Radiofrequency Renal Denervation for Uncontrolled Hypertension: A Cost-Effectiveness Analysis Based on the SPYRAL HTN-ON MED Trial for the Colombian Healthcare System
Author(s)
Carlos A. Eusse, MD1, Anne M. Ryschon, MA2, Khoa N. Cao, MBBS MPH MS2, JUAN D. TELLEZ, MD3, Diego M. Vanegas Cardona, MD1, Carlos A. Tenorio, MD1, Jan B. Pietzsch, PhD2;
1Clinica CardioVID, Medellin, Colombia, 2Wing Tech Inc., Menlo Park, CA, USA, 3Medtronic Inc., Medellin, Colombia
1Clinica CardioVID, Medellin, Colombia, 2Wing Tech Inc., Menlo Park, CA, USA, 3Medtronic Inc., Medellin, Colombia
Presentation Documents
OBJECTIVES: Radiofrequency renal denervation (RF RDN) is a guideline-recommended adjunctive treatment for uncontrolled hypertension, including resistant hypertension (rHTN). This study evaluated the cost-effectiveness of RF RDN in the Colombian healthcare system.
METHODS: A validated decision-analytic Markov model based on multivariate risk equations, including the Framingham equations, was used to model projected clinical events, quality-adjusted life years (QALYs) and costs over a lifetime horizon. Relative risks of clinical events 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). Clinical event risk reductions resulting from changes in office systolic blood pressure (oSBP) were based on a meta-regression of 47 hypertension randomized-controlled trials. The base case effect size of -4.9 mmHg oSBP reduction (treatment vs. sham control) was derived from the SPYRAL HTN-ON MED study, in which both groups maintained use of up to three antihypertensive medications. The analysis was conducted from the perspective of the Colombian healthcare system, with costs (in US$) and effects discounted by 3%. The lifetime incremental cost-effectiveness ratio (ICER) was evaluated against the accepted willingness-to-pay (WTP) threshold of three times the Colombian gross domestic product (GDP) per capita per QALY gained.
RESULTS: At 10 years, RF RDN resulted in significant clinical event risk reductions (0.80 for stroke, 0.88 for MI, 0.89 for AP/CHD, 0.72 for HF, 0.96 for ESRD, 0.86 for CVD, and 0.94 for ACD, respectively). Compared to a sham control and over a patient’s lifetime, RF RDN led to a 0.37 QALY gain at an incremental cost of $4,100, yielding an ICER of $11,017 per QALY gained, below the WTP threshold of $23,750 per QALY.
CONCLUSIONS: According to model-based projections, RF RDN is expected to be a cost-effective treatment for uncontrolled hypertension, including rHTN, in the Colombian healthcare system.
METHODS: A validated decision-analytic Markov model based on multivariate risk equations, including the Framingham equations, was used to model projected clinical events, quality-adjusted life years (QALYs) and costs over a lifetime horizon. Relative risks of clinical events were projected for stroke, myocardial infarction (MI), angina pectoris/coronary heart disease (AP/CHD), heart failure (HF), end-stage renal disease (ESRD), cardiovascular death (CVD) and all-cause death (ACD). Clinical event risk reductions resulting from changes in office systolic blood pressure (oSBP) were based on a meta-regression of 47 hypertension randomized-controlled trials. The base case effect size of -4.9 mmHg oSBP reduction (treatment vs. sham control) was derived from the SPYRAL HTN-ON MED study, in which both groups maintained use of up to three antihypertensive medications. The analysis was conducted from the perspective of the Colombian healthcare system, with costs (in US$) and effects discounted by 3%. The lifetime incremental cost-effectiveness ratio (ICER) was evaluated against the accepted willingness-to-pay (WTP) threshold of three times the Colombian gross domestic product (GDP) per capita per QALY gained.
RESULTS: At 10 years, RF RDN resulted in significant clinical event risk reductions (0.80 for stroke, 0.88 for MI, 0.89 for AP/CHD, 0.72 for HF, 0.96 for ESRD, 0.86 for CVD, and 0.94 for ACD, respectively). Compared to a sham control and over a patient’s lifetime, RF RDN led to a 0.37 QALY gain at an incremental cost of $4,100, yielding an ICER of $11,017 per QALY gained, below the WTP threshold of $23,750 per QALY.
CONCLUSIONS: According to model-based projections, RF RDN is expected to be a cost-effective treatment for uncontrolled hypertension, including rHTN, in the Colombian healthcare system.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE8
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)