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

Publication ,  Journal Article
Lubitz, CC; Economopoulos, KP; Sy, S; Johanson, C; Kunzel, HE; Reincke, M; Gazelle, GS; Weinstein, MC; Gaziano, TA
Published in: Circulation. Cardiovascular quality and outcomes
November 2015

Primary aldosteronism (PA) is a common and underdiagnosed 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. Changes in systolic blood pressure are subsequently converted into gains in quality-adjusted life years (QALYs) by applying National Health and Nutrition Examination Survey data on concomitant risk factors to an existing cardiovascular disease simulation model. QALYs and lifetime costs were then used to calculate incremental cost-effectiveness ratios for the competing strategies. The incremental cost-effectiveness ratio for the strategy of computerized tomography (CT) followed by adrenal venous sampling (AVS) was $82,000/QALY compared with treat all. Incremental cost-effectiveness ratios for CT alone and AVS alone were $200,000/QALY and $492,000/QALY; the other strategies were more costly and less effective. Integrating differential patient-reported health-related quality of life adjustments for patients with PA, and incremental cost-effectiveness ratios for screening patients with CT followed by AVS, CT alone, and AVS alone were $52,000/QALY, $114,000/QALY, and $269,000/QALY gained.CT scanning followed by AVS was a cost-effective strategy to screen for PA among patients with RH.

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Published In

Circulation. Cardiovascular quality and outcomes

DOI

EISSN

1941-7705

ISSN

1941-7713

Publication Date

November 2015

Volume

8

Issue

6

Start / End Page

621 / 630

Related Subject Headings

  • Treatment Failure
  • Tomography, X-Ray Computed
  • Time Factors
  • Risk Factors
  • Quality-Adjusted Life Years
  • Predictive Value of Tests
  • Patient Selection
  • Nutrition Surveys
  • Models, Economic
  • Mineralocorticoid Receptor Antagonists
 

Citation

APA
Chicago
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MLA
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Lubitz, C. C., Economopoulos, K. P., Sy, S., Johanson, C., Kunzel, H. E., Reincke, M., … Gaziano, T. A. (2015). Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients. Circulation. Cardiovascular Quality and Outcomes, 8(6), 621–630. https://doi.org/10.1161/circoutcomes.115.002002
Lubitz, Carrie C., Konstantinos P. Economopoulos, Stephen Sy, Colden Johanson, Heike E. Kunzel, Martin Reincke, G Scott Gazelle, Milton C. Weinstein, and Thomas A. Gaziano. “Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients.Circulation. Cardiovascular Quality and Outcomes 8, no. 6 (November 2015): 621–30. https://doi.org/10.1161/circoutcomes.115.002002.
Lubitz CC, Economopoulos KP, Sy S, Johanson C, Kunzel HE, Reincke M, et al. Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients. Circulation Cardiovascular quality and outcomes. 2015 Nov;8(6):621–30.
Lubitz, Carrie C., et al. “Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients.Circulation. Cardiovascular Quality and Outcomes, vol. 8, no. 6, Nov. 2015, pp. 621–30. Epmc, doi:10.1161/circoutcomes.115.002002.
Lubitz CC, Economopoulos KP, Sy S, Johanson C, Kunzel HE, Reincke M, Gazelle GS, Weinstein MC, Gaziano TA. Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients. Circulation Cardiovascular quality and outcomes. 2015 Nov;8(6):621–630.

Published In

Circulation. Cardiovascular quality and outcomes

DOI

EISSN

1941-7705

ISSN

1941-7713

Publication Date

November 2015

Volume

8

Issue

6

Start / End Page

621 / 630

Related Subject Headings

  • Treatment Failure
  • Tomography, X-Ray Computed
  • Time Factors
  • Risk Factors
  • Quality-Adjusted Life Years
  • Predictive Value of Tests
  • Patient Selection
  • Nutrition Surveys
  • Models, Economic
  • Mineralocorticoid Receptor Antagonists