An Early Value Assessment of Biomarker-Guided Precision Medicine for Treatment-Resistant Hypertension: A Headroom and Threshold Analysis

Treatment-resistant hypertension (TRH), defined as uncontrolled blood pressure despite the use of three or more antihypertensive drugs or requiring four or more drugs for control, affects 10.3% of patients with hypertension and increases cardiovascular risk. Biomarker-guided precision treatments have the potential to address unmet needs in TRH. This health economic modelling study assessed the headroom (that is the maximum potential value of a hypothetical biomarker-guided treatment strategy with zero treatment costs and 100% effectiveness) in the TRH population in general, then in a specific subgroup with elevated levels of NADPH oxidase 5 (NOX5-positive). A decision tree and a state transition model were developed to estimate headroom in patients with TRH and in the NOX5-positive subgroup (assumed to comprise 25% of the population). The model adopted a Dutch healthcare perspective over a lifetime horizon, estimating costs and quality-adjusted life years (QALYs), with a net monetary benefit threshold of €20,000 per QALY. Uncertainty was explored through sensitivity, scenario and threshold analyses. The room for improvement in TRH patients includes 2.94 additional life years, 3.45 QALYs, and €23,292 cost savings per patient. Successfully diagnosing and treating NOX5-positive patients could yield a gain of 0.53 life years and 0.63 QALYs, with cost savings of €4835 per patient. The biomarker-guided treatment remained cost effective even at annual costs of €5045 per patient or if only two of 1000 patients were NOX5-positive and successfully treated. Patients with TRH have room for improvement in life expectancy, quality of life, and cardiovascular outcomes with a biomarker-guided treatment strategy. These findings support further research and development of targeted treatments to address this unmet medical need.