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Geisler BP, Egan BM, Cohen JT, Garner AM, Akehurst RL, Esler MD, Pietzsch JB. Clinical Effectiveness and Cost-Effectiveness of Catheter-Based Renal Denervation. J Am Coll Cardiol 2012;60:1271–7.
In further work on the model after the publication, a conversion error in the formula for mortality status post-myocardial infarction (for the time period beyond the first month) was detected that led to an increased cardiovascular mortality.
The corrected formula reads: ProbToProb (tDieMI [sbp; yr]; cl * if (psa =1; if (age < 60; 1; if (age ≥ 70; dRRdieMI70s;dRRdieMI60s)); tRRdieMIage [age])).
After incorporating this correction into the model, the primary outcomes changed as follows. Relative morbidity risks did not change except for heart failure (0.78/0.94 for 10 years/lifetime instead of 0.79/0.92 previously). Renal denervation-related life year gains are slightly reduced compared to the published results (1.28 instead of 1.30 incremental life years and 1.07 instead of 1.10 incremental quality-adjusted life years [QALYs]). However, the incremental cost-effectiveness ratio (ICER) becomes marginally more favorable and changes from $3,071/QALY to $1,017/QALY (an intervention with an ICER of $50,000 to $100,000 per QALY is typically considered to be cost-effective). The corresponding 95% credible interval for the ICER, derived from probabilistic sensitivity analysis, changes from (cost-saving; $31,460/QALY) to (cost-saving; $35,103/QALY). This effect might stem from the longer survival status post myocardial infarction, which leads to a cost increase for both the renal denervation and the standard-of-care strategies, but reduces the cost difference between the two. All conclusions of the study remain unchanged.
The authors apologize for this error.
- American College of Cardiology Foundation