Cost-Effectiveness of Radiofrequency Renal Denervation for Resistant Hypertension in Australia.

AIM: Radiofrequency renal denervation (RF RDN) is a guideline-recommended, minimally invasive therapy for patients with uncontrolled, including resistant, hypertension. This analysis assesses the cost-effectiveness of RF RDN compared with optimal medical management for treatment of resistant hypertension in the Australian health care setting on the basis of contemporary clinical data.

METHOD: A previously published and validated decision-analytic Markov model was adapted to the Australian health care setting. Primary health states modelled included hypertension, myocardial infarction, stroke, heart failure), angina pectoris/coronary artery disease, end-stage renal disease, and all-cause mortality, with transitions among health states informed by multivariate risk equations. Costs (reported in 2025 Australian Dollar [AUD]$) and utilities were sourced from fee schedules and published literature. The base case modelled a resistant hypertension cohort, informed by registry data, in whom treatment with RF RDN reduced office systolic blood pressure by -5.2 mmHg, based on sham-adjusted results from the SPYRAL HTN-ON MED randomised controlled trial. The primary outcomes included 5-year clinical event rates, in addition to strategy-specific costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio over lifetime. Cost-effectiveness was assessed against an assumed willingness-to-pay threshold of AUD$50,000 per QALY gained. Costs and effects were discounted 5% per annum in accordance with Australian cost-effectiveness guidelines. Extensive scenario and sensitivity analyses were conducted.

RESULTS

At 5 years, RF RDN yielded meaningful reductions in clinical events (relative risks of 0.80 for stroke, 0.88 for myocardial infarction, and 0.71 for heart failure). Under the base-case assumptions, RF RDN was associated with incremental costs of AUD$10,396 and QALYs of 0.28, producing a lifetime incremental cost-effectiveness ratio of AUD$36,655 per QALY gained. RF RDN was shown to be cost-effective across the range of scenario and sensitivity analyses explored.

CONCLUSIONS

Blood pressure reductions observed with RF RDN are projected to lead to meaningful clinical event reductions that render the therapy a cost-effective adjunctive treatment option for patients with resistant hypertension in Australia.