JCH: Cost effectiveness of blood pressure device uncertain

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DRAFT In addition to lowering blood pressure, the implantable carotid body stimulator Rheos (CVRx, Minneapolis) may be economical, with an incremental cost-effectiveness ratio between $50,000 and $100,000 per quality-adjusted life-years, according to a study in this month’s Journal of Clinical Hypertension.

Kate C. Young, PhD, from the division of vascular surgery at the School of Medicine and Dentistry at the University of Rochester in Rochester, N.Y., and colleagues said the purposes of the study were to investigate the cost effectiveness of Rheos for treating resistant hypertension, and to determine the range of starting systolic blood pressure (BP) values where the device remains cost effective.

The researchers modeled direct costs of $2,007, utilities and event rates for future MI, stroke, heart failure and end-stage renal disease. Also, the incremental cost-effectiveness ratio (ICER) for Rheos was $64,400 per quality-adjusted life-years (QALYs) using Framingham-derived event probabilities.

The target population was an asymptomatic 50-year-old cohort with uncontrolled hypertension, despite polypharmacologic management, and no history of cardiovascular disease or stroke.

According to the authors, the ICER was less than $100,000 per QALY for systolic BPs of 142 mm Hg or higher. A probability of device removal of less than 1 percent per year, or systolic BP reductions of at least 24 mm Hg, were variables that decreased the ICER below $50,000 per QALY.

For cohort characteristics similar to Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure–Lowering Arm (ASCOT-BPLA) participants, the ICER became $26,700 per QALY. Two-way sensitivity analyses demonstrated that lowering SBP 12 mm Hg from 220 mm Hg, or 21 mm Hg from 140 mm Hg, were required.

The authors wrote that the “ICER for Rheos falls in a grey area between too expensive (more than $100,000 per QALY) and an acceptable price (less than $50,000 per QALY),” partly because the “costs of the actual device or the surgery have not been definitively established.”

However, they noted that the “cost effectiveness of Rheos was comparable to other implantable devices analyzed within the setting of U.S. healthcare," as it is “within the range of values” for implantable cardiac defibrillators.

Young and colleagues concluded that Rheos’ cost effectiveness is dependent on the starting systolic BP, performance of the device and risks of the target population.