(VP030) COST-EFFECTIVENESS OF RADIOFREQUENCY RENAL DENERVATION FOR TREATMENT OF UNCONTROLLED HYPERTENSION: A CANADIAN PERSPECTIVE

Background: Catheter-based radiofrequency renal denervation (RF RDN) is an interventional treatment for uncontrolled hypertension. Here, we evaluate the cost-effectiveness of RF RDN in the context of the Canadian healthcare system using recent data from the SPYRAL HTN-ON MED randomized clinical trial (RCT) (NCT02439775).

METHODS AND RESULTS: A decision-analytic Markov model based on multivariate risk equations was used to project clinical events, quality-adjusted survival, and costs over 10 years and lifetime. The model consisted of six health states: hypertension alone, myocardial infarction, other symptomatic coronary artery disease, stroke, heart failure, and end-stage kidney disease. Risk reduction associated with changes in office systolic blood pressure (oSBP) in the treatment group was estimated based on a published meta-regression of 47 hypertension RCTs. The base case effect size (change in oSBP, observed vs. sham control) was derived from the SPYRAL HTN-ON MED full cohort results, demonstrating a significant oSBP reduction of -4.9 mmHg compared with sham control. This effect size was assumed to be maintained over lifetime. The analysis was conducted from a Canadian provincial healthcare payer perspective, with a 3% discount rate applied to costs (2022 CAD) and effects. The incremental cost-effectiveness ratio (ICER), calculated as the ratio of incremental cost and incremental gain in quality-adjusted life years (QALY) was evaluated against a willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life year (QALY) gained.

RF RDN resulted in projected relative risk reductions in clinical events over 10 years (0.80 for stroke, 0.88 for myocardial infarction, 0.72 for heart failure), with an increase in health benefits over lifetime. RF RDN added 0.38 QALYs (13.69 vs. 13.31) at a concurrent cost increase of $8,935 ($63,708 vs. $54,772), resulting in an ICER of $23,442 per QALY gained. The ICER finding was very robust in deterministic sensitivity analysis, with RF RDN treatment cost and effect size the main drivers of variation. In probabilistic sensitivity analysis, RF RDN was 91.8% and 100.0% likely to be cost-effective at WTP of $30,000 and $50,000 per QALY, respectively.

Conclusion: According to model-based projections of the latest trial evidence, catheter-based RF RDN is a cost-effective strategy for the treatment of uncontrolled hypertension in the Canadian healthcare system, with an ICER substantially below the commonly referenced cost-effectiveness threshold.