Cost-effectiveness of radiofrequency renal denervation for uncontrolled and resistant hypertension in The Netherlands

Introduction: Radiofrequency renal denervation (RF RDN) has been recommended as an adjunct therapeutic option for uncontrolled including resistant hypertension. This analysis sought to evaluate the cost-effectiveness of RF RDN treatment in the Dutch healthcare setting. Methods: A previously published decision-analytic model was utilised to project outcomes over a lifetime horizon for RF RDN vs. standard of care (SoC). Data from the SPYRAL HTN-ON MED study informed the cohort characteristics and base case treatment effect modelled (−4.9 mmHg office-based systolic blood pressure (oSBP) reduction vs. sham), while alternate assumptions were explored in sensitivity analyses. Cost-effectiveness was evaluated against a burden of disease-determined threshold of €20,000 per quality-adjusted life year gained, according to Dutch guidelines. Results: In the base case, ten-year clinical event risk reductions were 0.80 for stroke, 0.88 for myocardial infarction, 0.89 for angina pectoris and coronary heart disease, 0.72 for heart failure, 0.96 for end-stage renal disease, and 0.93 for all-cause death. Over lifetime and under the base case effect size, RF RDN resulted in increased costs of €4,137 (€46,769 (RF RDN) vs. €42,632 (SoC)) and quality-adjusted life years (QALY) of 0.61 (17.49 RF RDN vs. 16.88 SoC), with an incremental cost-effectiveness ratio (ICER) of €6,784 per QALY gained. RF RDN was highly cost-effective or dominant across the range of scenario and sensitivity analyses performed. Conclusion: Over lifetime, RF RDN was found cost-effective in the Dutch healthcare system, with an ICER substantially below the applicable willingness-to-pay threshold, while providing meaningful reductions in clinical events for uncontrolled including resistant hypertension patients.