Oral Virtual Presentation (Virtual only) ESA-SRB-ANZBMS 2021

Cost-effectiveness of screening for primary aldosteronism in hypertensive patients (#56)

Maame Esi Woode 1 , Kristina Wong 2 3 , Christopher Reid 4 , Michael Stowasser 5 , Grant Russell 6 , Stella Gwini 7 8 , Morag Young 9 , Peter Fuller 2 3 , Gang Chen 1 , Jun Yang 2 3
  1. Centre for Health Economics, Monash University, Caulfield, Victoria, Australia
  2. Department of Medicine, Monash University, Clayton, Victoria, Australia
  3. Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Clayton, Victoria, Australia
  4. School of Population Health, Curtin University, Perth, Western Austrialia, Australia
  5. Endocrine Hypertension Research Centre, University of Queensland Diamantina Institute, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  6. Department of General Practice, Monash University, Clayton, Victoria, Australia
  7. Barwon Health, University Health Hospital Geelong, Geelong, Victoria, Australia
  8. School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
  9. Cardiovascular Endocrinology Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia

Introduction:

Primary aldosteronism (PA) affects 3%-13% of hypertensive patients in the primary care setting and up to 30% in the hypertensive referral units. Although the Endocrine Society Guidelines recommend screening for PA in patients with severe or treatment-resistant hypertension, the diagnosis of PA at an earlier stage of the disease has the potential to prevent end-organ damage and optimise patient outcomes.

 

Objective:

This study aimed to estimate the cost effectiveness of screening for PA in treatment- and disease (cardiovascular disease and stroke)-naïve hypertensive patients.

 

Methods:

A Markov Model was used to compare the costs and effectiveness of screening for PA. Within the model, a 40-year-old patient with hypertension went through either the screened or unscreened arm of the model and was modelled until age 80 or death.  In the screening arm, the patient underwent screening and standard diagnostic testing for PA. The main outcome of interest was the Incremental Cost Effectiveness Ratio (ICER) and a willingness to pay threshold of AU$50,000 was used.

 

Results:

Screening hypertensive patients for PA as compared to not screening attained an ICER of AU$21,768 per quality-adjusted life year gained. The results were robust to different sensitivity analyses, in particular, screening was cost-effective irrespective of the discount rate and duration of follow-up beyond 5 years.

 

Discussion and Conclusion:

The results from this study demonstrated that screening all hypertensive patients for PA from age 40 is cost-effective because the ICER is lower than the willingness to pay threshold.  The data suggest that screening for PA should be performed before the development of severe or treatment-resistant hypertension in the Australian healthcare setting.