Original Title: Radiofrequency renal denervation

Authors' objectives: HTW aimed to identify and summarise evidence that addressed the following question: What is the clinical and cost effectiveness of renal denervation for people with resistant hypertension when compared to standard care?

Authors' results and conclusions: We identified a recent Cochrane systematic review that reported on the clinical effectiveness of renal denervation (ultrasound and radiofrequency) for the treatment of resistant hypertension. We also identified a further two relevant randomised control trials (RCTs) that were published after the systematic review and one longer-term follow-up of an included review. This evidence, included in this report, focuses on earlier iterations of renal denervation and we identified no studies that use newer treatment protocols with multi-electrode radiofrequency for resistant hypertension. Evidence identified in the literature and an updated meta-analysis completed by HTW does not show significant improvements in systolic or diastolic 24-hour ambulatory blood pressure monitoring (ABPM) after renal denervation for resistant hypertension. Evidence on non-fatal cardiovascular events and hospitalisation is limited by the fact that studies are not powered or designed with long enough follow-ups to observe anticipated differences. The economic analysis suggests that renal denervation is not a cost-effective intervention. Renal denervation was associated with an improvement in clinical effects that resulted in higher quality-adjusted life years (QALYs) than standard care but at an incremental cost that resulted in an incremental cost-effectiveness ratio (ICER) of over £70,000 per QALY. There is a high level of uncertainty regarding whether the findings seen here would be replicated in newer treatment protocols as no evidence relating to these in the resistant hypertension population was identified. Newer approaches use a larger number of ablations in the main artery and branches and it is possible that this approach would deliver improved benefits. Forthcoming trials may provide some evidence from sub-group analyses. However, additional larger trials focusing on this population may be needed.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Project Status: Completed

Year Published: 2023

URL for published report: https://healthtechnology.wales/reports-guidance/radiofrequency-renal-denervation/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: Floor 3, 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk