Potential lifetime cost-effectiveness of catheter-based renal sympathetic denervation in patients with resistant hypertension

Abstract

Renal sympathetic denervation is a cost-effective intervention for patients with resistant hypertension. Earlier treatment produces better cost-effectiveness ratios.

Prevalence and Characteristics of Treatment-Resistant Hypertension among Hypertensive Japanese Outpatients

“…In terms of surrogate endpoints, there is already evidence that renal denervation decreases arrhythmias such as atrial fibrillation, proteinuria, diabetes, sleep apnea syndrome, congestive heart failure, arteriosclerosis, and left ventricular remodeling [24]- [31]. More recently, it was reported that renal denervation improves depression and the quality of life [32] [33], while targeting suitable patients may contribute to reduction of medical expenses.…”

Renal denervation in treatment-resistant hypertension: a reappraisal

“…In particular, more than 20 cases of de novo renal artery stenosis have been reported after RDN, most of them after the announcement that Symplicity HTN-3 failed to meet its primary endpoint [20][21][22] ( Table 2). In view of these results, previous pharmacoeconomic [23][24][25] analyses became irrelevant, because they were based on weak assumptions. RDN deserves further investigation but is not ready for clinical use and should be restricted to research protocols [26].…”

Design Considerations for Clinical Trials of Autonomic Modulation Therapies Targeting Hypertension and Heart Failure

“…Cost-effectiveness analyses have been reported for renal denervation and baroreceptor activation therapy, but these initial studies were based on hypothetical patient cohorts and anticipated large decreases in SBP (which were not confirmed in SYMPLICITY HTN-3). 50,51 Prospective economic assessments should be included as end points (usually secondary) in major clinical trials, but the analysis methodology and interpretation of these data are not always straightforward, particularly in multinational trials. [52][53][54][55] Collecting data on health status is also informative, although the data may be difficult to interpret in unblinded trials.…”

“…Para la denervación renal y el tratamiento de activación de barorreceptores se han informado análisis de costo-eficacia, sin embargo, estos estudios iniciales se fundamentaron en cohortes hipotéticas de pacientes y previeron amplias disminuciones de la PAS (las que no fueron confirmadas en SYMPLICITY-HTN-3). [50][51] Las evaluaciones económicas prospectivas deberían incluirse como criterios de valoración (usualmente secundarios) en ensayos clínicos importantes, pero la metodología de análisis y la interpretación de estos datos no siempre son claras, en particular en ensayos multinacionales. [52][53][54][55] La recopilación de datos sobre el estado de salud también es informativa, aunque es posible que en ensayos sin enmascaramiento los datos sean difíciles de interpretar.…”