Renal Denervation Shown Highly Cost Effective
Although renal denervation has an estimated up-front cost of about $12,500, the long-term benefits of the blood pressure reduction it usually produces are so potent that the treatment winds up costing about $3,000 for each additional quality-adjusted life-year it confers on patients, based on a cost-effectiveness analysis of data from the Symplicity HTN-2 trial.
This level of cost effectiveness is "more than an order of magnitude below the recognized threshold of $50,000/QALY [quality-adjusted life-year]," and provides fairly compelling evidence that "catheter-based renal denervation therapy is a cost-effective treatment strategy for resistant hypertension," Dr. Benjamin P. Geisler and his associates wrote in a report published online in September (J. Am. Coll. Cardiol. 2012 [doi:10.1016/j.jacc.2012.07.029]).
They based their cost-effectiveness model on data collected in the Symplicity HTN-2 trial (Lancet 2010;376:1903-9), described in the main story.
"When you look at societal decision making – how much a society is willing to pay for improved quality of life and increased duration of life – the recognized threshold in the United States is a cost of $50,000 or less/QALY. That means that $3,000/QALY is highly cost effective," said Jan B. Pietzsch, Ph.D., the lead investigator of the analysis. "It’s a very low incremental cost-effectiveness ratio compared with other innovative treatments," he said in an interview.
The model that Dr. Geisler, Dr. Pietzsch, and their associates produced estimated a sizeable impact that this blood-pressure reduction would have on improved survival, and on a reduced incidence of several cardiovascular disease end points presuming that the reduced blood pressure was sustained for 10 years, or for the rest of a patient’s life. For example, they estimated that over the 10 years following treatment, renal denervation would cut the incidence of stroke by 3.4 percentage points, the rate of coronary heart disease by 5.4 percentage points, the rate of cardiovascular mortality by 3.8 percentage points, and all-cause death by 3.5 percentage points. They also calculated an increase in median survival of 1.3 years.
They calculated a discounted, lifetime incremental cost-effectiveness ratio of $3,071/QALY. In addition, they found this incremental cost per quality-adjusted life-year was "quite robust" across a range of stating blood pressures, said Dr. Pietzsch, president of Wing Tech, a consulting company based in the United States and Germany.
At starting blood pressures of less than 172 mm Hg, renal denervation was actually cost saving. At a baseline pressure of 172 mm Hg or greater the cost per QALY increased steadily with baseline pressure, to a maximum or about $7,000/QALY in patients who had a systolic blood pressure of 200 mm Hg at the time they underwent renal denervation.
Dr. Pietzsch, Dr. Geisler, and another coauthors work for Wing Tech Inc., which provided consultant services to Medtronic Ardian to construct this health-economic model. (Medtronic Ardian is the company that markets the Symplicity catheter.) Another coauthor received salary support from Medtronic Ardian, a second coauthor received consultancy payments and travel expenses from Medtronic Ardian, and a third coauthor serves on the board of a group that received funding from Medtronic.