Publications

2017
Rush B, Tyler PD, Stone DJ, Geisler BP, Walley KR, Celi LA. Outcomes of Ventilated Patients With Sepsis Who Undergo Interhospital Transfer: A Nationwide Linked Analysis. Crit Care Med. 2017;Abstract
OBJECTIVES: The outcomes of critically ill patients who undergo interhospital transfer are not well understood. Physicians assume that patients who undergo interhospital transfer will receive more advanced care that may translate into decreased morbidity or mortality relative to a similar patient who is not transferred. However, there is little empirical evidence to support this assumption. We examined country-level U.S. data from the Nationwide Readmissions Database to examine whether, in mechanically ventilated patients with sepsis, interhospital transfer is associated with a mortality benefit. DESIGN: Retrospective data analysis using complex survey design regression methods with propensity score matching. SETTING: The Nationwide Readmissions Database contains information about hospital admissions from 22 States, accounting for roughly half of U.S. hospitalizations; the database contains linkage numbers so that admissions and transfers for the same patient can be linked across 1 year of follow-up. PATIENTS: From the 2013 Nationwide Readmission Database Sample, 14,325,172 hospital admissions were analyzed. There were 61,493 patients with sepsis and on mechanical ventilation. Of these, 1,630 patients (2.7%) were transferred during their hospitalization. A propensity-matched cohort of 1,630 patients who did not undergo interhospital transfer was identified. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The exposure of interest was interhospital transfer to an acute care facility. The primary outcome was hospital mortality; the secondary outcome was hospital length of stay. The propensity score included age, gender, insurance coverage, do not resuscitate status, use of renal replacement therapy, presence of shock, and Elixhauser comorbidities index. After propensity matching, interhospital transfer was not associated with a difference in in-hospital mortality (12.3% interhospital transfer vs 12.7% non-interhospital transfer; p = 0.74). However, interhospital transfer was associated with a longer total hospital length of stay (12.8 d interquartile range, 7.7-21.6 for interhospital transfer vs 9.1 d interquartile range, 5.1-17.0 for non-interhospital transfer; p < 0.01). CONCLUSIONS: Patients with sepsis requiring mechanical ventilation who underwent interhospital transfer did not have improved outcomes compared with a cohort with matched characteristics who were not transferred. The study raises questions about the risk-benefit profile of interhospital transfer as an intervention.
Tyler PD, Stone DJ, Geisler BP, McLennan S, Celi LA, Rush B. Racial and Geographic Disparities in Interhospital ICU Transfers. Crit Care Med. 2017;Abstract
OBJECTIVES: Interhospital transfer, a common intervention, may be subject to healthcare disparities. In mechanically ventilated patients with sepsis, we hypothesize that disparities not disease related would be found between patients who were and were not transferred. DESIGN: Retrospective cohort study. SETTING: Nationwide Inpatient Sample, 2006-2012. PATIENTS: Patients over 18 years old with a primary diagnosis of sepsis who underwent mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We obtained age, gender, length of stay, race, insurance coverage, do not resuscitate status, and Elixhauser comorbidities. The outcome used was interhospital transfer from a small- or medium-sized hospital to a larger acute care hospital. Of 55,208,382 hospitalizations, 46,406 patients met inclusion criteria. In the multivariate model, patients were less likely to be transferred if the following were present: older age (odds ratio, 0.98; 95% CI, 0.978-0.982), black race (odds ratio, 0.79; 95% CI, 0.70-0.89), Hispanic race (odds ratio, 0.79; 95% CI, 0.69-0.90), South region hospital (odds ratio, 0.79; 95% CI, 0.72-0.88), teaching hospital (odds ratio, 0.31; 95% CI, 0.28-0.33), and do not resuscitate status (odds ratio, 0.19; 95% CI, 0.15-0.25). CONCLUSIONS: In mechanically ventilated patients with sepsis, we found significant disparities in race and geographic location not explained by medical diagnoses or illness severity.
Geisler BP, Huygens SA, Reardon MJ, Mieghem NV, Kappetein AP, Osnabrugge RLJ, et al. Cost-effectiveness and Projected Survival of Self-expanding Transcatheter versus Surgical Aortic Valve Replacement for High Risk Patients in a European Setting. A Dutch Analysis Based on the CoreValve High-Risk Trial. Structural Heart [Internet]. 2017;(ja) :null. Free full textAbstract
ABSTRACTBackground: Clinical and economic outcomes of self-expanding bioprosthesis transcatheter aortic valve implantation (TAVI) in high-risk surgical candidates are unknown in the European setting. The objective is to project life expectancy and estimate the cost-effectiveness of TAVI in a European setting.Methods: Cost-utility analysis via probabilistic Markov modeling was performed. A simulated cohort of 83-year old men and women (53 and 47%, respectively) with severe aortic stenosis at high but not extreme surgical risk were observed in the CoreValve High Risk Trial. Costs were based on resource use data from a Dutch academic medical center and costing guidelines. Undiscounted life expectancy and discounted costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), and proportion cost-effective at a willingness-to-pay threshold of €50,000/QALY were evaluated. Beyond the base case, further analyses explored a “lean scenario” that considered a shorter TAVI procedure time and hospital stay.Results: Mean projected survival increased by 0.65 life years (5.62 for TAVI vs. 4.97 for SAVR). TAVI was projected to add 0.41 (3.69 vs. 3.27) QALYs at an increased cost of €9,048 (€51,068 vs. €42,020), resulting in an ICER of €21,946 per QALY gained. The probability of TAVI being cost-effective was 71%. Further cost reduction of approximately €5,400 in addition to the “lean” assumptions would make TAVI the dominant strategy.Conclusion: A self-expanding TAVI system for high-risk surgical candidates increases quality-adjusted life expectancy at an economically acceptable cost in the Dutch setting. Reductions in procedure time and length of hospital stay will further improve the value of TAVI.
Pietzsch JB, Geisler BP, Ikeno F. Cost-effectiveness of orbital atherectomy compared to rotational atherectomy in treating patients with severely calcified coronary artery lesions in Japan. Cardiovasc Interv Ther. 2017;Abstract
Compared to rotational atherectomy (RA), orbital atherectomy (OA) has been shown to decrease procedure failure and reintervention rates in the treatment of severely calcified coronary artery lesions. Our objective was to explore the cost-effectiveness of OA compared to RA in the Japanese healthcare system. A decision-analytic model calculated reintervention rates and consequent total 1-year costs. Effectiveness inputs were therapy-specific target lesion revascularization (TLR) rates and all-cause mortality, pooled from clinical studies. Index and reintervention costs were determined based on claims data analysis of n = 33,628 subjects treated in 2014-2016. We computed incremental cost-effectiveness in Japanese Yen (JPY) per life year (LY) gained based on differences in 1-year cost and projected long-term survival, assuming OA device cost between JPY 350,000 and ​JPY 550,000. OA was found to be associated with improved clinical outcomes (12-month TLR rate 5.0 vs. 15.7%) and projected survival gain (8.34 vs. 8.16 LYs (+0.17), based on 1-year mortality of 5.5 vs. 6.8%). Total 1-year costs were lower for device cost of JPY 430,000 or less, and reached a maximum ICER of JPY 753,445 per LY at the highest assumed device cost, making OA dominant or cost-effective across the tested range, at ICERs substantially below the willingness-to-pay threshold. In conclusion, orbital atherectomy for the treatment of severely calcified coronary artery lesions, compared to rotational atherectomy, is a cost-effective treatment approach in the Japanese healthcare system due to improved clinical performance.
Feller-Kopman D, Liu S, Geisler BP, DeCamp MM, Pietzsch JB. Response to Lee et al. J Thorac Oncol. 2017;12 (9) :e152-e153.
Geisler BP, Ji YD, Peacock ZS. Value in Oral and Maxillofacial Surgery: A Systematic Review of Economic Analyses. J Oral Maxillofac Surg. 2017;Abstract
PURPOSE: The purpose of this study is to describe the state of economic analyses in the field of oral and maxillofacial surgery (OMS). MATERIALS AND METHODS: A systematic search of published literature up to 2016 was performed. The inclusion criteria were as follows: English-language articles on economic analyses pertaining to OMS including anesthesia and pain management; dentoalveolar surgery; orthognathic, cleft, and/or obstructive sleep apnea treatment; pathology; reconstruction; temporomandibular disorders; trauma; and other. The exclusion criteria were as follows: opinion or perspective articles, studies unrelated to OMS, nonhuman research, and implant-related studies. Cost-effectiveness analyses (CEAs), cost-utility analyses, and cost-minimization analyses (CMAs) were evaluated with the original Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist or a modified CHEERS checklist. RESULTS: The search yielded 798 articles, 77 of which met the inclusion criteria (published from 1980 to 2016, 48 from the United States). There were an increasing number of studies over time (P for trend < .01). There were 7 economic studies on anesthesia and pain management (9.1%); 16 studies on dentoalveolar surgery (20.7%); 15 studies on orthognathic, cleft, and/or obstructive sleep apnea treatment (19.4%); 1 study on pathology (1.3%); 6 studies on reconstruction (7.8%); no studies on temporomandibular joint disorders and/or facial pain (0%); 20 studies on trauma (25.9%); and 12 studies categorized as other (15.5%). CEAs made up 11.7% of studies, and CMAs comprised 58.4%. Of the 9 CEAs, 55.6% were published in 2010 or later. Of the 45 CMAs, 88.6% were published in 2000 or later and 61.4% in 2010 or later. CEAs met 56.0% (range, 29.2 to 87.5%) of the CHEERS criteria, whereas CMA studies met 45.1% (range, 23.9 to 76.1%) of the modified CHEERS criteria. Only 1 study succeeded in estimating costs and health outcomes (value) of an OMS procedure. CONCLUSIONS: There is an increasing trend in the number of economic studies in the field of OMS. More high-quality economic evaluations are needed to demonstrate the value of OMS procedures. To determine value, future studies should compare both costs and health-related outcomes.
Geisler BP, Ji YD, Peacock ZS. Value in Oral and Maxillofacial Surgery: A Systematic Review of Economic Analyses. Journal of Oral and Maxillofacial Surgery [Internet]. 2017; Publisher's VersionAbstract

Purpose: The purpose of this study is to describe the state of economic analyses in the field of oral and maxillofacial surgery (OMS).

Materials and Methods: A systematic search of published literature up to 2016 was performed. The inclusion criteria were as follows: English-language articles on economic analyses pertaining to OMS including anesthesia and pain management; dentoalveolar surgery; orthognathic, cleft, and/or obstructive sleep apnea treatment; pathology; reconstruction; temporomandibular disorders; trauma; and other. The exclusion criteria were as follows: opinion or perspective articles, studies unrelated to OMS, nonhuman research, and implant-related studies. Cost-effectiveness analyses (CEAs), cost-utility analyses, and cost-minimization analyses (CMAs) were evaluated with the original Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist or a modified CHEERS checklist.

Results: The search yielded 798 articles, 77 of which met the inclusion criteria (published from 1980 to 2016, 48 from the United States). There were an increasing number of studies over time (P for trend < .01). There were 7 economic studies on anesthesia and pain management (9.1%); 16 studies on dentoalveolar surgery (20.7%); 15 studies on orthognathic, cleft, and/or obstructive sleep apnea treatment (19.4%); 1 study on pathology (1.3%); 6 studies on reconstruction (7.8%); no studies on temporomandibular joint disorders and/or facial pain (0%); 20 studies on trauma (25.9%); and 12 studies categorized as other (15.5%). CEAs made up 11.7% of studies, and CMAs comprised 58.4%. Of the 9 CEAs, 55.6% were published in 2010 or later. Of the 45 CMAs, 88.6% were published in 2000 or later and 61.4% in 2010 or later. CEAs met 56.0% (range, 29.2 to 87.5%) of the CHEERS criteria, whereas CMA studies met 45.1% (range, 23.9 to 76.1%) of the modified CHEERS criteria. Only 1 study succeeded in estimating costs and health outcomes (value) of an OMS procedure.

Conclusions: There is an increasing trend in the number of economic studies in the field of OMS. More high-quality economic evaluations are needed to demonstrate the value of OMS procedures. To determine value, future studies should compare both costs and health-related outcomes.

Feller-Kopman D, Liu S, Geisler BP, DeCamp MM, Pietzsch JB. Cost-Effectiveness of a Bronchial Genomic Classifier for the Diagnostic Evaluation of Lung Cancer. J Thorac Oncol. 2017;12 (8) :1223-1232. Abstract
INTRODUCTION: The use of a bronchial genomic classifier has been shown to improve the diagnostic accuracy of bronchoscopy for suspected lung cancer by identifying patients who may be more suitable for radiographic surveillance as opposed to invasive procedures. Our objective was to assess the cost-effectiveness of bronchoscopy plus a genomic classifier versus bronchoscopy alone in the diagnostic work-up of patients at intermediate risk for lung cancer. METHODS: A decision-analytic Markov model was developed to project the costs and effects of two competing strategies by using test performance from the Airway Epithelial Gene Expression in the Diagnosis of Lung Cancer-1 and Airway Epithelial Gene Expression in the Diagnosis of Lung Cancer-2 studies. The diagnostic accuracy of noninvasive and invasive follow-up, as well as associated adverse event rates, were derived from published literature. Procedure costs were based on claims data and 2016 inpatient and outpatient reimbursement amounts. The model projected the number of invasive follow-up procedures, 2-year costs and quality-adjusted life-years (QALYs) by strategy, and resulting incremental cost-effectiveness ratio discounted at 3% per annum. RESULTS: Use of the genomic classifier reduced invasive procedures by 28% at 1 month and 18% at 2 years, respectively. Total costs and QALY gain were similar with classifier use ($27,221 versus $27,183 and 1.512 versus 1.509, respectively), resulting in an incremental cost-effectiveness ratio of $15,052 per QALY. CONCLUSIONS: Our analysis suggests that the use of a genomic classifier is associated with meaningful reductions in invasive procedures at about equal costs and is therefore a high-value strategy in the diagnostic work-up of patients at intermediate risk of lung cancer.
2016
Geisler BP. Cardiovascular Benefits of the Mediterranean Diet Are Driven by Stroke Reduction and Possibly by Decreased Atrial Fibrillation Incidence. Am J Med. 2016;129 (1) :e11.
Heffron SP, Alviar CL, Towe C, Geisler BP, Axel L, Galloway AC, et al. Dyspnea and Chest Pain in a Young Woman Caused by a Giant Pericardial Lymphohemangioma: Diagnosis and Treatment. Can J Cardiol. 2016;32 (10) :1260.e23-1260.e25. Abstract
We describe a 21-year-old woman who presented with chest pain and dyspnea on exertion and who was found to have a large pericardial mass. Multimodality imaging was instrumental in narrowing the differential diagnosis and planning surgical treatment, which included coronary artery bypass and right-sided heart reconstruction. The final pathologic diagnosis was lymphohemangioma; to our knowledge, this was the largest cardiac/pericardial vascular tumor ever to be reported in the literature.
Katsanos K, Geisler BP, Garner AM, Zayed H, Cleveland T, Pietzsch JB. Economic analysis of endovascular drug-eluting treatments for femoropopliteal artery disease in the UK. BMJ Open. 2016;6 (5) :e011245. Abstract
OBJECTIVES: To estimate the clinical and economic impact of drug-eluting endovascular treatment strategies for femoropopliteal artery disease compared with current standard of care. DESIGN: Systematic literature search to pool target lesion revascularisations (TLR). Model-based per-patient cost impact and quasi-cost-effectiveness projection over 24 months based on pooled TLRs and current reimbursement. SETTING: The UK's National Health Service (NHS). PARTICIPANTS: Patients presenting with symptomatic femoropopliteal disease eligible for endovascular treatment. INTERVENTIONS: Current National Institute for Health and Care Excellence (NICE) guideline-recommended treatment with percutaneous transluminal balloon angioplasty (PTA) and bailout bare metal stenting (BMS) versus primary BMS placement, or drug-coated balloon (DCB), or drug-eluting stent (DES) treatment. PRIMARY AND SECONDARY OUTCOME MEASURES: 24-month per-patient cost impact to NHS (primary outcome). SECONDARY OUTCOMES: pooled 24-month TLR rates; numbers needed to treat (NNTs); cost per TLR avoided and estimated incremental cost-effectiveness ratio (ICER) in £ per quality-adjusted life year (QALY). RESULTS: N=28 studies were identified, reporting on 5167 femoropopliteal lesions. Over 24 months, DCB, DES and BMS reduced TLRs of de novo lesions from 36.2% to 17.6%, 19.4% and 26.9%, respectively, at an increased cost of £43, £44 and £112. NNTs to avoid 1 TLR in 24 months were 5.4, 6.0 and 10.8, resulting in cost per TLR avoided of £231, £264 and £1204. DCB was estimated to add 0.011 QALYs, DES 0.010 QALYs and BMS 0.005 QALYs, resulting in estimated ICERs of £3983, £4534 and £20 719 per QALY gained. A subset analysis revealed more favourable clinical and economic outcomes for a 3.5 µg/mm(2) DCB with urea excipient, compared with the rest of DCBs. A modest reduction of 10% in DCB and DES prices made drug-eluting treatments dominant. CONCLUSIONS: Widespread adoption of drug-eluting endovascular therapies for femoropopliteal disease would add meaningful clinical benefit at reasonable additional costs to the NHS. Based on currently available data, DCBs offer the highest clinical and economic value.
2015
Pietzsch JB, Busca R, Geisler BP. Adoption Of Transcatheter Aortic Valve Replacement In Germany: Utilization Patterns And Case Volumes Compared To Surgical Aortic Valve Replacement In The Period 2009-2013. Value Health. 2015;18 (7) :A370.
Geisler BP, Raad RA, Esaian D, Sharon E, Schwartz DR. Apical ballooning and cardiomyopathy in a melanoma patient treated with ipilimumab: a case of takotsubo-like syndrome. J Immunother Cancer. 2015;3 :4. Abstract
Although animal studies have shown that the immunomodulator ipilimumab causes inflammation of the myocardium, clinically significant myocarditis has been observed only infrequently. We report a case of suspected acute coronary syndrome without a culprit lesion on cardiac angiography and takotsubo cardiomyopathy (TC)-like appearance on echocardiography in a patient with metastatic melanoma who received four standard doses of ipilimumab. Apical ballooning, hyperdynamic basal wall motion, systolic anterior motion of the mitral valve, and associated severe left ventricular outflow tract obstruction were present. Restaging with positron emission tomography-computed tomography done soon after discharge incidentally revealed increased fludeoxyglucose uptake in the apex. This case illustrates that a TC-like syndrome might be caused by autoimmune myocarditis after ipilimumab treatment although this was not biopsy-confirmed. Post-marketing surveillance should capture cardiac events occurring in patients treated with ipilimumab to better document and clarify a relationship to the drug, and biopsies should be considered. Physicians utilizing this novel agent should be aware of the potential for immune-related adverse events.
Neumann A, Mostardt S, Biermann J, Gelbrich G, Goehler A, Geisler BP, et al. Cost-effectiveness and cost-utility of a structured collaborative disease management in the Interdisciplinary Network for Heart Failure (INH) study. Clin Res Cardiol. 2015;104 (4) :304-9. Abstract
BACKGROUND: Non-pharmacological treatment programmes are being developed, in which specialised nurses take care of heart failure (HF) patients. Such disease management programmes might increase survival and quality of life in HF patients, but evidence on their cost-effectiveness remains limited. METHODS AND RESULTS: A prospective economic evaluation piggy-backed onto the randomised controlled Interdisciplinary Network for Heart Failure (INH) Study weighted costs of the intervention HeartNetCare -HF™ (HNC) regarding effectiveness, mortality and quality-adjusted life years (QALYs). To consider uncertainty sensitivity analyses were performed. Compared to usual care (UC), HNC revealed 8,284 per death avoided within the 6 month study follow-up period. The cost-utility analysis showed additional costs of 49,335 per QALY. CONCLUSION: Although HNC did not reduce short-term re-admission rates of HF patients hospitalised for cardiac decompensation within the first 180 days after discharge, HNC might reduce mortality and increase quality of life in these patients at reasonable costs. Therefore, long-term HNC-effects deserve further evaluation.
Busca R, Geisler BP, Pietzsch JB. Cost-Effectiveness of Transcatheter Aortic Valve Replacement: Current Decision-Analytic Models and Future Opportunities. Value Health. 2015;18 (7) :A359.
Pietzsch JB, Geisler BP, Zeller T. Endovascular Interventions For Treatment Of Femoropopliteal Peripheral Artery Disease: Updated Budget Impact Analysis For Germany Based On Latest Clincal Evidence. Value Health. 2015;18 (7) :A349.
2014
Pietzsch JB, Geisler BP, Esler MD. Estimated Added Benefit Of Catheter-Based Renal Denervation For Moderate Treatment-Resistant Hypertension: Impact Of Age And Cardiovascular Risk Factors. Value Health. 2014;17 (7) :A474.
Pietzsch JB, Geisler BP, Garner AM, Zeller T, Jaff MR. Economic analysis of endovascular interventions for femoropopliteal arterial disease: a systematic review and budget impact model for the United States and Germany. Catheter Cardiovasc Interv. 2014;84 (4) :546-54. Abstract
OBJECTIVES: To study the economic impact on payers and providers of the four main endovascular strategies for the treatment of infrainguinal peripheral artery disease. BACKGROUND: Bare metal stents (BMS), drug-eluting stents (DES), and drug-coated balloons (DCB) are associated with lower target lesion revascularization (TLR) probabilities than percutaneous transluminal angioplasty (PTA), but the economic impact is unknown. METHODS: In December 2012, PubMed and Embase were systematically searched for studies with TLR as an endpoint. The 24-month probability of TLR for each treatment was weighted by sample size. A decision-analytic Markov model was used to assess the budget impact from payers' and facility-providers' perspectives of the four index procedure strategies (BMS, DES, DCB, and PTA). Base cases were developed for U.S. Medicare and the German statutory sickness fund perspectives using current 2013 reimbursement rates. RESULTS: Thirteen studies with 2,406 subjects were included. The reported probability of TLR in the identified studies varied widely, particularly following treatment with PTA or BMS. The pooled 24-month probabilities were 14.3%, 19.3%, 28.1%, and 40.3% for DCB, DES, BMS, and PTA, respectively. The drug-eluting strategies had a lower projected budget impact over 24 months compared to BMS and PTA in both the U.S. Medicare (DCB: $10,214; DES: $12,904; uncoated balloons $13,114; BMS $13,802) and German public health care systems (DCB €3,619; DES €3,632; BMS €4,026; PTA €4,290). CONCLUSIONS: DCB and DES, compared to BMS and PTA, are associated with lower probabilities of target lesion revascularization and cost savings for U.S. and German payers.
Geisler BP, Ghosh A. Gabapentin treatment for alcohol dependence. JAMA Intern Med. 2014;174 (7) :1201.
2012
Geisler BP, Egan BM, Cohen JT, Garner AM, Akehurst RL, Esler MD, et al. Cost-effectiveness and clinical effectiveness of catheter-based renal denervation for resistant hypertension. J Am Coll Cardiol. 2012;60 (14) :1271-7. Abstract
OBJECTIVES: The purpose of this study was to assess cost-effectiveness and long-term clinical benefits of renal denervation in resistant hypertensive patients. BACKGROUND: Resistant hypertension affects 12% of hypertensive persons. In the Symplicity HTN-2 randomized controlled trial, catheter-based renal denervation (RDN) lowered systolic blood pressure by 32 ± 23 mm Hg from 178 ± 18 mm Hg at baseline. METHODS: A state-transition model was used to predict the effect of RDN and standard of care on 10-year and lifetime probabilities of stroke, myocardial infarction, all coronary heart disease, heart failure, end-stage renal disease, and median survival. We adopted a societal perspective and estimated an incremental cost-effectiveness ratio in U.S. dollars per quality-adjusted life-year, both discounted at 3% per year. Robustness and uncertainty were evaluated using deterministic and probabilistic sensitivity analyses. RESULTS: Renal denervation substantially reduced event probabilities (10-year/lifetime relative risks: stroke 0.70/0.83; myocardial infarction 0.68/0.85; all coronary heart disease 0.78/0.90; heart failure 0.79/0.92; end-stage renal disease 0.72/0.81). Median survival was 18.4 years for RDN versus 17.1 years for standard of care. The discounted lifetime incremental cost-effectiveness ratio was $3,071 per quality-adjusted life-year. Findings were relatively insensitive to variations in input parameters except for systolic blood pressure reduction, baseline systolic blood pressure, and effect duration. The 95% credible interval for incremental cost-effectiveness ratio was cost-saving to $31,460 per quality-adjusted life-year. CONCLUSIONS: The model suggests that catheter-based renal denervation, over a wide range of assumptions, is a cost-effective strategy for resistant hypertension that might result in lower cardiovascular morbidity and mortality.

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