Radiofrequency Renal Denervation for Uncontrolled Hypertension: A Cost-Effectiveness Analysis Based on the SPYRAL HTN-ON MED Trial for the Colombian Healthcare System
Moderator
Anne M Ryschon, MA, Wing Tech Inc., FORT CALHOUN, NE, United States
Speakers
Carlos Eusse; Khoa Cao; JUAN TELLEZ; Diego Vanegas Cardona; Carlos Tenorio; Jan B Pietzsch, PhD, Wing Tech Inc., Menlo Park, CA, United States
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)