Primary Aldosteronism Screen Cost-Effective in Resistant Hypertension

This article originally appeared here.
Findings for computed tomography scanning followed by adrenal venous sampling.
Findings for computed tomography scanning followed by adrenal venous sampling.

(HealthDay News) -- For patients with resistant hypertension (RH), computed tomography (CT) scanning followed by adrenal venous sampling (AVS) is a cost-effective screen for primary aldosteronism (PA), according to a study published online in Circulation: Cardiovascular Quality and Outcomes.

Carrie C. Lubitz, MD, MPH, from Massachusetts General Hospital in Boston, and colleagues examined whether the long-term cardiovascular benefit of identifying and treating surgically correctable PA outweighs the increased upfront costs. A decision-analytic model was used to compare aggregate costs and systolic blood pressure changes for 6 diagnostic strategies for PA in a simulated population of at-risk RH patients. A seventh strategy whereby all patients were treated with a mineralocorticoid-receptor antagonist without further testing was also evaluated. Changes in systolic blood pressure were converted into gains in quality-adjusted life-years (QALYs); incremental cost-effectiveness ratios were calculated using QALYs and lifetime costs.

The researchers found that, compared with treating all, the incremental cost-effectiveness ratio for CT followed by AVS was $82,000/QALY. For CT alone and AVS alone, the incremental cost-effectiveness ratios were $200,000/QALY and $492,000/QALY, respectively; other strategies were less effective and more costly.

"Primary hyperaldosteronism is a common disease that is currently, grossly underdiagnosed and treated," the authors write. "Our results suggest that CT followed by AVS is a cost-effective strategy to screen for PA among patients with RH."

Source

  1. Lubitz CC, Economopoulos KP, Sy S, et al. Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients. Circ Cardiovasc Qual Outcomes. doi: 10.1161/CIRCOUTCOMES.115.002002.
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