Primary Aldosteronism Screening Cost-Effective in Resistant Hypertension

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CT scanning plus adrenal venous sampling proved to be cost effective in screening for primary aldosteronism.
CT scanning plus adrenal venous sampling proved to be cost effective in screening for primary aldosteronism.

(HealthDay News) — For patients with resistant hypertension, computed tomography (CT) scanning followed by adrenal venous sampling is a cost-effective screen for primary aldosteronism, according to a study published 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 (CV) benefit of identifying and treating surgically correctable primary aldosteronism 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 primary aldosteronism in a simulated population of at-risk patients with resistant hypertension. 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 adrenal venous sampling was $82 000 per QALY. For CT alone and adrenal venous sampling alone, the incremental cost-effectiveness ratios were $200 000 per QALY and $492 000 per QALY, respectively; other strategies were less effective and more costly.

"Primary hyperaldosteronism is a common disease that is currently, grossly underdiagnosed and treated," the researchers wrote. "Our results suggest that CT followed by [adrenal venous sampling] is a cost-effective strategy to screen for [primary aldosteronism] among patients with [resistant hypertension]."

Reference

  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. 2015;doi:10.1161/CIRCOUTCOMES.115.002002.
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