Cost Effectiveness of Catheter-Based Renal Denervation for Treatment Resistant Hypertension – an Australian Payer Perspective

Abstract

A LT H 1 7 ( 2 0 1 4 ) A 7 1 9 -A 8 1 3 (SOC) vs SOC alone in the US health care setting. The objective of this analysis is to assess the cost-effectiveness of RDN in patients with TR-HTN from the Australian payer perspective. Methods: Geisler methods were largely retained but life tables, resource use, costs and discount rates were revised to reflect Australian parameters. Importantly, the treatment effect of RDN was based on a meta-analysis of all studies (regardless of catheter used) enrolling TR-HTN patients (SBP ≥ 160 mmHg despite > 3 anti-hypertensive drugs including a diuretic). The model consisted of 30 health states and employed multivariate risk equations from large-scale cohort studies to calculate transition probabilities of events and event mortality. Discounted (5%) costs and outcomes were calculated over a lifetime horizon. Results: The weighted mean decrease in office-based SBP over 6 months was -28.1 mmHg (95% CI: -24.5 to -31.6). The RDN procedure cost ($10,724.22) was partially offset by lower event costs -primarily through a reduced incidence of stroke (-0.0559) and MI (-0.0524). RDN was associated with higher incremental costs ($5,951.04) and additional QALYs (0.4296) resulting in an incremental cost per QALY of $13,852. Sensitivity analyses demonstrated reliability of the base case results across a wide range of assumptions. ConClusions: Consideration of both clinical and economic evaluations may be necessary to inform reimbursement decision making. Based upon this analysis, RDN is a cost effective treatment option for patients with rHTN in Australia. However, this conclusion is dependent upon the magnitude of SBP reduction with RDN and assumptions related to long term patient outcomes.objeCtives: Hypertension represents a major health problem, affecting more than 21% of adults in the Philippines. Amlodipine, a calcium channel blocker, is considered to have better tolerance and effectiveness than other classes of antihypertensive treatments. Limited studies have examined the cost-effectiveness of Amlodipine in the Philippines. The purpose of this study was to compare the costs and effectiveness associated with Amlodipine and Angiotensin II Receptor Blockers (Valsartan) in preventing stroke and myocardial infarction (MI) among Filipino hypertension patients. Methods: A Markov model was developed using effectiveness, rate of stroke and MI, survival and utility data from published literature. Costs of drugs, direct medical costs of hypertension management, stroke/MI treatment, and follow-up management were included. Costs were based on a survey on experts in the Philippines except costs of MI treatments, which was retrieved from the literature. Total costs and QALYs in a five-year time horizon were calculated and compared between Amlodipine and Valsartan. The modeling was conducted with 10,000 hypertension patients in the Amlodipine and Valsartan arms respectively. Discounting rate used for costs and QALYs was 3%. Third-party payer perspective was adopted. Results: In the base case analysis, Am...

Cost-effectiveness of Interventional therapies for management of Treatment-resistant hypertension: systematic review of pharmacoeconomic studies

“…Almost all studies were from developed countries. Two studies from USA, [ 15,17 ] two studies from Australia [ 38,39 ] two studies from UK [ 40,41 ] and one study from each of six countries: Canada, [ 42 ] the Netherlands, [ 43 ] Germany, [ 44 ] Russia, [ 45 ] Korea, [ 46 ] Mexico [ 47 ] were included. Concerning the perspectives of the studies, seven were done from payer perspective, followed by four from health system perspective and one from societal perspective.…”

“…Most of the studies used lifetime Markov’s model to quantify cost‐effectiveness of interventional therapies for the treatment of true drug‐resistant hypertension. With regard to types of interventional methods studied, almost all 11 (91.7%) evaluated cost‐effectiveness of renal denervation therapy [ 15,38–47 ] and only one study evaluated the cost‐effectiveness of ceratoid baroreceptor stimulation therapy [ 17 ] (Table 3).…”

“…Resulting in an incremental cost per QALY gained of $13 852 and it is a cost effective for treatment‐resistant hypertension at willingness‐to‐pay thresholds of $25 000 and $50 000/QALY for 18.2 and 12.2 mmHg systolic blood pressure reductions, respectively. [ 39 ] The cost‐effectiveness was evaluated for 10 years and lifetime horizon. Input parameters were based on meta‐analysis of all studies.…”

“…With regard to types of interventional methods studied, almost all 11(91.7%) evaluated cost‐effectiveness of renal denervation therapy and only one study evaluated the cost‐effectiveness of carotid baroreceptor stimulation. [ 15,17,38–47 ]…”

“…The study findings were specific to the country under study and could not be generalised to other countries. [ 15,17,38–47 ] This is due to difference in socio‐economic status of countries like GDP per capita and difference in willingness to pay among different societies. There were a few studies from developing countries, probably due to lack access to technology and expertise in interventional cardiology.…”