Preferences for Subtyping Primary Aldosteronism: A Discrete Choice Experiment.

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Health Economics

Background:

• Primary aldosteronism (PA) affects 10-15% of hypertensive individuals, increasing cardiovascular risk.
• Accurate differentiation between unilateral and bilateral PA is crucial for optimal treatment, often necessitating adrenal vein sampling (AVS).
• Emerging subtyping strategies include predictive algorithms and nuclear imaging, offering potential alternatives to AVS.

Purpose of the Study:

• To investigate the preferences of hypertensive individuals regarding different primary aldosteronism (PA) subtyping strategies.
• To understand patient priorities concerning test accuracy, waiting time, adverse effects, and out-of-pocket costs for PA diagnosis.

Main Methods:

• Two discrete choice experiments (DCEs) were employed to assess preferences for PA subtyping methods.
• Latent class conditional logit (LCL) modeling was used to segment participants based on preferences.
• Policy simulation analyses examined how age, sex, and income influence subtyping uptake.

Main Results:

• 85% of 583 hypertensive Australian adults were willing to undergo PA subtyping.
• Participants prioritized accuracy, followed by shorter waiting times, minimal adverse effects, and lower costs.
• Algorithm-based methods showed the highest initial uptake (~54%), increasing to 68% when cost was considered.

Conclusions:

• Patient preferences for PA subtyping are significantly influenced by cost, invasiveness, and waiting time.
• Less-invasive, faster, and low-cost methods are favored, even with slightly lower accuracy than AVS.
• Further research should focus on optimizing algorithm accuracy and clinical implementation of preferred subtyping methods.