OBJECTIVES : Blood pressure (BP) reduction in uncontrolled hypertension (HTN) is associated with reduced risk for cerebro-cardiovascular (CV) events and end-stage renal-disease (ESRD). The safety and efficacy of catheter-based percutaneous renal denervation (RDN) for reducing BP has been demonstrated in patients with uncontrolled HTN, including so-called “treatment resistant” hypertension (trHTN)(uncontrolled BP despite prescription of ≥ 3 antihypertensive drugs). We assessed the economic impact of RDN in trHTN from the Italian healthcare (NHS) perspective, considering the potential economic benefits through avoidance of potential CV events and ESRD.

METHODS : A 10-year horizon budget impact model was developed from the NHS perspective for a scenario including RDN vs one without. The model estimated CV events and ESRD from multi-variate risk equations (updated from a previous model), and event reductions for RDN were modelled from published meta-regression analyses. RDN BP reductions (office SBP): 6.55 (SPYRAL HTN ON-MED pilot study) and 21.55 (Global SYMPLICITY Registry). The costs of hypertension-related events and treatment were identified through a literature review; The Italian DRG tariff was used as proxy for procedure cost of RDN.

RESULTS : An increase in the use of RDN over 10 years to a 8% adoption rate in the target population resulted in a reduction of CV events and ESRD that would translate to economic benefits for RDN of 68-133Mio€ over 10 years, depending on the extent of BP reductions . Overall, considering also the upfront procedural costs, the RDN scenario would still lead to an additional modest budget impact to the health care system, representing 1.4-2.3% of the total 10-year-budget for treating trHTN. The annual per patient incremental cost would be 64-110€.

CONCLUSIONS : Increasing adoption of RDN treatment would allow the avoidance of CV and ESRD morbidity and mortality, with an estimated impact on the NHS budget for trHTN patients of up to 2.3% in Italy.