BACKGROUND: Most experts agree that primary hyperaldosteronism (PHA) caused by an aldosterone-producing adenoma (APA) is best treated by adrenalectomy. From a public health standpoint, the cost of treatment must be considered. We sought to compare the current guideline-based (surgical) strategy with universal pharmacologic management to determine the optimal strategy from a cost perspective. METHODS: A decision analysis was performed using a Markov state transition model comparing the strategies for PHA treatment. Pharmacologic management for all patients with PHA was compared with a strategy of screening for and resecting an aldosterone-producing adenoma. Success rates were determined for treatment outcomes based on a literature review. Medicare reimbursement rates were calculated to estimate costs from a third-party payer perspective. RESULTS: Screening for and resecting APAs was the least costly strategy in this model. For a reference patient with 41 remaining years of life, the discounted expected cost of the surgical strategy was $27,821. The discounted expected cost of the medical strategy was $34,691. The cost of adrenalectomy would have to increase by 156% to $22,525 from $8,784 for universal pharmacologic therapy to be less costly. Screening for APA is more costly if fewer than 9.6% of PHA patients have resectable APA. CONCLUSION: Resection of APAs was the least costly treatment strategy in this decision analysis model.
BACKGROUND: Most experts agree that primary hyperaldosteronism (PHA) caused by an aldosterone-producing adenoma (APA) is best treated by adrenalectomy. From a public health standpoint, the cost of treatment must be considered. We sought to compare the current guideline-based (surgical) strategy with universal pharmacologic management to determine the optimal strategy from a cost perspective. METHODS: A decision analysis was performed using a Markov state transition model comparing the strategies for PHA treatment. Pharmacologic management for all patients with PHA was compared with a strategy of screening for and resecting an aldosterone-producing adenoma. Success rates were determined for treatment outcomes based on a literature review. Medicare reimbursement rates were calculated to estimate costs from a third-party payer perspective. RESULTS: Screening for and resecting APAs was the least costly strategy in this model. For a reference patient with 41 remaining years of life, the discounted expected cost of the surgical strategy was $27,821. The discounted expected cost of the medical strategy was $34,691. The cost of adrenalectomy would have to increase by 156% to $22,525 from $8,784 for universal pharmacologic therapy to be less costly. Screening for APA is more costly if fewer than 9.6% of PHA patients have resectable APA. CONCLUSION: Resection of APAs was the least costly treatment strategy in this decision analysis model.
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 Journal: Circ Cardiovasc Qual Outcomes Date: 2015-11-10
Authors: Jung Min Lee; Mee Kyoung Kim; Seung Hyun Ko; Jung Min Koh; Bo Yeon Kim; Sang Wan Kim; Soo Kyung Kim; Hae Jin Kim; Ohk Hyun Ryu; Juri Park; Jung Soo Lim; Seong Yeon Kim; Young Kee Shong; Soon Jib Yoo Journal: Endocrinol Metab (Seoul) Date: 2017-06
Authors: Fengjie Tang; Lih M Loh; Roger S Foo; Wann J Loh; Dawn S T Lim; Meifen Zhang; Pei T Tan; Du S Swee; Joan Khoo; Donovan Tay; Lynette Lee; Sarah Y Tan; Ling Zhu; Shui B Soh; Eberta Tan; Peng C Kek; Troy H Puar Journal: J Endocr Soc Date: 2021-08-31
Authors: Mateusz Wierdak; Grzegorz Sokołowski; Michał Natkaniec; Karolina Morawiec-Sławek; Piotr Małczak; Piotr Major; Alicja Hubalewska-Dydejczyk; Andrzej Budzyński; Michał Pędziwiatr Journal: Wideochir Inne Tech Maloinwazyjne Date: 2018-04-03 Impact factor: 1.195