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Cost-effectiveness analysis of screening for primary aldosteronism in China
Na Li1,2, Jingze Huang3, Bin Zheng1,2
1Department of Pharmacy, Fujian Medical University Union Hospital, Fuzhou, China.
Insights
Screening all patients with hypertension for primary aldosteronism (PA) is cost-effective. This approach saves costs and improves health outcomes compared to only screening high-risk individuals.
Area of Science:
- Endocrinology
- Health Economics
- Cardiovascular Medicine
Background:
- Primary aldosteronism (PA) is a frequently underdiagnosed cause of hypertension.
- PA contributes to significant cardiovascular and cerebrovascular events, increasing healthcare costs.
- Effective screening strategies are crucial for early diagnosis and management.
Purpose of the Study:
- To evaluate the cost-effectiveness of different primary aldosteronism (PA) screening strategies in Chinese hypertensive patients.
- To compare screening high-risk hypertensive patients versus screening all hypertensive patients.
- To determine the most economically viable PA screening method.
Main Methods:
- A 30-year simulation using decision tree and Markov models.
- Incorporated epidemiological data, clinical efficacy, costs, and quality-adjusted life years (QALYs).
- Performed cost-effectiveness analysis, including univariate and probabilistic sensitivity analyses.
Main Results:
- Screening all hypertensive patients yielded 15.77 QALYs at a cost of $2482.15.
- Screening high-risk patients yielded 15.75 QALYs at a cost of $2488.39.
- The strategy of screening all hypertensive patients was found to be cost-saving with superior health outcomes.
Conclusions:
- Screening all hypertensive patients for PA is a cost-effective strategy within China's healthcare system.
- This approach offers better health outcomes and lower overall costs compared to selective screening.
- Early and universal PA screening can reduce the burden of associated cardiovascular and cerebrovascular diseases.
Objective:
Primary aldosteronism (PA) is an underdiagnosed cause of hypertension. Although the medical costs will increase if all patients with elevated blood pressure are screened, the number of missed diagnosed patients with PA and the medical resources subsequently consumed by adverse cardiovascular and cerebrovascular events can be reduced. This study aimed to conduct economic evaluation PA screening strategies in Chinese patients with hypertension, that is PA screening in patients with high-risk hypertension and all patients with hypertension, to determine the cost-effective method.
Methods:
The decision tree and Markov model were constructed using TreeAge Pro 2020. Using the latter, a 30-year course of hypertension after different screening strategies was simulated, with a cycle of one year. The model parameters included epidemiological data, clinical efficacy, cost and effectiveness. The total cost of treatment and quality-adjusted life year (QALY) were simulated to conduct a cost-effectiveness analysis. Univariate and probabilistic sensitivity analyses of the model were also performed.
Results:
PA screening patients with high-risk hypertension and all patients with hypertension obtained 15.75 and 15.77 QALYs and the costs were $2488.39 and $2482.15, respectively. The strategy of PA screening in all patients with hypertension is cost-saving and produces more health outcomes. The sensitivity analysis showed that the results were reliable.
Conclusion:
From the perspective of China's health system, the strategy of screening all hypertensive patients for PA may be more cost-effective than screening only high-risk patients and providing standard antihypertensive treatment for low-risk hypertensive patients.
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