Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients


Primary aldosteronism (PA) is a common and under-diagnosed disease with significant morbidity potentially cured by surgery. We aim to assess if the long-term cardiovascular benefits of identifying and treating surgically correctable PA outweigh the upfront increased costs in patients at the time patients are diagnosed with resistant hypertension (RH). A decision-analytic model compares aggregate costs and systolic blood pressure changes of 6 recommended or implemented diagnostic strategies for PA in a simulated population of at-risk RH patients. We also evaluate a 7th “treat all” strategy wherein all patients with RH are treated with a mineralocorticoid-receptor antagonist without further testing at RH diagnosis. CT scanning followed by AVS was a cost-effective strategy to screen for PA among patients with resistant hypertension.

Authors: Carrie C. Lubitz, Konstantinos P. Economopoulos, Stephen Sy, Colden Johanson, Heike E. Kunzel, Martin Reincke, G. Scott Gazelle, Milton C. Weinstein,Thomas A. Gaziano
Keywords: screening, cost-effectiveness
DOI Number: 10.1161/CIRCOUTCOMES.115.002002      Publication Year: 2015

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