Renal Denervation vs. Pharmacotherapy for Resistant and Uncontrolled Hypertension: A Systematic Review of Cost-effectiveness Analyses

Introduction. Cardiovascular morbidity and mortality are associated with hypertension. Catheter-based renal denervation has been successfully used to treat resistant hypertension. The present study aimed to evaluate the cost-effectiveness of RDN compared with standard medical therapy in patients with resistant (RH) and uncontrolled hypertension (UH). Methods. Literature searches were performed in PubMed, EMBASE, Web of science, Scopus and google scholar for full economic evaluations on RDN in patients with resistant and uncontrolled hypertension published between 1990 and 2026. Articles were screened for relevance based on preset inclusion and exclusion criteria. Final Studies in the review graded using the Quality of Health Economic Studies (QHES) instrument. Results. A total of 43 articles were identified using our defined criteria. Two types of studies were identified: cost-effectiveness studies and cost-utility studies, the majority of which were cost-utility studies (69%). The average quality score was 89.6 (range 65-95). Treatment with RDN resulted in a 30% reduction in cardiovascular mortality. The lowest and highest incremental cost per quality adjusted life years for patients with UH were observed in Canada ($10,055.5) and Taiwan ($63,802.35), respectively. These values for patients with RH were reported in the Netherlands ($2,187.5) and Australia ($39,613). Conclusion. The results of this systematic review indicate that RDN is a cost-effective intervention in most cost-effectiveness models. In order to more accurately estimate the economic value of RDN, future research based on long-term clinical data and in diverse health system settings is necessary.