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Fig. 3. —Graph shows cost–utility trade-off of evaluation and
treatment strategies in medication-resistant hypertension. Natural history of
medication-resistant hypertension represents base case (BC) and results in
least costly strategy with shortest quality-adjusted life expectancy. All
alternative strategies increase quality-adjusted life expectancy at increased
expense. Slope of line drawn between BC and each of other strategies estimates
relative cost-effectiveness of alternatives. Steeper slope corresponds to less
cost-effective strategy, relative to other alternative strategies. Thus,
enhanced medical therapy without imaging (Med) is less cost-effective than any
of other strategies incorporating preliminary imaging. MR angiography (MRA) is
most cost-effective strategy compared with BC and dominates medical therapy
and CT angiography (CTA) strategies. Conventional angiography (CA) is
cost-effective alternative to MRA.
