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The main explanation for these differences is the lower incidence of cardiac and cerebrovascular diseases in hypertensive patients in Spain relative to their northern European counterparts. Similarly, the risk of CVA as a first event in the base cohort over a year horizon would be 4. One factor that has a substantial impact on the cost of Barostim is the need for battery replacement throughout the patient's lifetime.

This finding can be explained by the current price of the battery, which requires replacement every 6 years. Thus, the ICER would be decreased by future reductions in the cost of the batteries or improvements in their service life.. One of the main limitations of this study is the lack of robust information on the effectiveness of Barostim in periods longer than 3 years.

The data on the long-term effectiveness of the device ie, to the end of the patient's life included in the analysis were based on a report showing a decrease of 35 mmHg after a mean follow-up of 2. Second, costs related to possible adverse effects associated with Barostim were not included in the calculations. The adverse effects identified were related to implantation of the device and included permanent nerve damage 4. Lastly, as there are no studies on heart failure risk in the Spanish population, this factor was measured using the original Framingham equations.

Although Barostim is effective in reducing SBP and progression to undesirable health states in the short term, based on the current prices and considering a willingness to pay of 30 euros per QALY, it is not a cost-effective option for treating the hypertensive population refractory to drug therapy in the Spanish health care setting..

This study was partially funded by the SEC. Descargar PDF. Marcelo Soto a ,. Autor para correspondencia. Table 1. Table 6. Introduction and objectives In Spain, 0. The aim of this study was to analyze the cost-effectiveness of Barostim compared with drug therapy in hypertensive patients refractory to conventional treatment at least 3 antihypertensive drugs, including 1 diuretic agent.

Methods We used a Markov model adapted to the epidemiology of the Spanish population to simulate the natural history of a cohort of patients with refractory hypertension over their lifetime. Deterministic and probabilistic sensitivity analyses were conducted. Results Barostim increased the number of quality-adjusted life years by 0.

The results were robust. Conclusions Barostim is not a cost-effective strategy for the treatment of refractory hypertension in Spain. The cost-effectiveness ratio could be improved by future reductions in the cost of the battery. Los resultados fueron robustos. Palabras clave:.

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Texto completo. METHODS Design A cost-effectiveness analysis was conducted using a model developed by Markov 6 in which patients start in hypertensive status refractory to drug therapy and progress over time toward several possible health states Figure 1.

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The model was based on a study carried out in the German population, 5 and was adapted to the epidemiologic characteristics and health costs of Spain for the present study. Figure 1. Table 2. Angina Canadian Cardiovascular Society functional class I. At 3 months after the acute episode. Table 3. Direct Health Care Costs. Includes pharmacologic therapy euros and 1 yearly visit to a specialist 32 euros.

Includes 2 yearly visits to a specialist. Table 4. Table 5.

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Figure 2. QALY, quality-adjusted life year. Figure 3. Figure 4. Appendix A. Sampietro-Colom, J.

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Brugada-Terradellas, J. Rev Esp Cardiol. Ramos Guerrero, D. Jarast Olivari, et al. Estudio de prevalencia en una consulta hospitalaria.

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Arrieta Blanco, M. Medrano Albero. Rev Esp Salud Publica. Mancia, R. Fagard, K. Narkiewicz, J. Zanchetti, M. J Hypertens. Borisenko, J. Beige, E. Lovett, U. Hoppe, S. Cost-effectiveness of Barostim therapy for the treatment of resistant hypertension in European settings.

Sonnenberg, J.

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Markov models in medical decision making: a practical guide. Med Decis Making. Weinstein, G. Torrance, A. Value Health. Drummond, M. Sculpher, G.