Cost-effectiveness of screening for primary aldosteronism in hypertensive patients in Australia: A Markov modelling analysis
Background:Primary aldosteronism affects 3-14% of hypertensive patients in the primary care setting and up to 30% in the hypertensive referral units. Although primary aldosteronism screening is recommended in patients with treatment-resistant hypertension, diagnosis at an earlier stage of disease ma...
| Main Authors: | , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
| Published: |
2023
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| Subjects: | |
| Online Access: | http://purl.org/au-research/grants/nhmrc/1184927 http://hdl.handle.net/20.500.11937/93777 |
| _version_ | 1848765787209203712 |
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| author | Woode, M.E. Wong, K. Reid, Christopher Stowasser, M. Russell, G. Gwini, S. Young, M.J. Fuller, P.J. Yang, J. Chen, G. |
| author_facet | Woode, M.E. Wong, K. Reid, Christopher Stowasser, M. Russell, G. Gwini, S. Young, M.J. Fuller, P.J. Yang, J. Chen, G. |
| author_sort | Woode, M.E. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Background:Primary aldosteronism affects 3-14% of hypertensive patients in the primary care setting and up to 30% in the hypertensive referral units. Although primary aldosteronism screening is recommended in patients with treatment-resistant hypertension, diagnosis at an earlier stage of disease may prevent end-organ damage and optimize patient outcomes.Methods:A Markov model was used to estimate the cost-effectiveness of screening for primary aldosteronism in treatment and disease (cardiovascular disease and stroke) naive hypertensive patients. Within the model, a 40-year-old patient with hypertension went through either the screened or the unscreened arm of the model. They were followed until age 80 or death. In the screening arm, the patient underwent standard diagnostic testing for primary aldosteronism if the screening test, aldosterone-to-renin ratio, was elevated above 70 pmol/l: mU/l. Diagnostic accuracies, transition probabilities and costs were derived from published literature and expert advice. The main outcome of interest was the incremental cost effectiveness ratio (ICER).Results:Screening hypertensive patients for primary aldosteronism compared with not screening attained an ICER of AU$35 950.44 per quality-adjusted life year (QALY) gained. The results were robust to different sensitivity analyses. Probabilistic sensitivity analysis demonstrated that in 73% of the cases, it was cost-effective to screen at the commonly adopted willingness-to-pay (WTP) threshold of AU$50 000.Conclusion:The results from this study demonstrated that screening all hypertensive patients for primary aldosteronism from age 40 is cost-effective. The findings argue in favour of screening for primary aldosteronism before the development of severe hypertension in the Australian healthcare setting. |
| first_indexed | 2025-11-14T11:40:48Z |
| format | Journal Article |
| id | curtin-20.500.11937-93777 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | eng |
| last_indexed | 2025-11-14T11:40:48Z |
| publishDate | 2023 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-937772024-01-11T02:09:56Z Cost-effectiveness of screening for primary aldosteronism in hypertensive patients in Australia: A Markov modelling analysis Woode, M.E. Wong, K. Reid, Christopher Stowasser, M. Russell, G. Gwini, S. Young, M.J. Fuller, P.J. Yang, J. Chen, G. Humans Aged, 80 and over Adult Cost-Benefit Analysis Australia Hypertension Hyperaldosteronism Quality-Adjusted Life Years Markov Chains Humans Hypertension Hyperaldosteronism Markov Chains Quality-Adjusted Life Years Adult Aged, 80 and over Cost-Benefit Analysis Australia Background:Primary aldosteronism affects 3-14% of hypertensive patients in the primary care setting and up to 30% in the hypertensive referral units. Although primary aldosteronism screening is recommended in patients with treatment-resistant hypertension, diagnosis at an earlier stage of disease may prevent end-organ damage and optimize patient outcomes.Methods:A Markov model was used to estimate the cost-effectiveness of screening for primary aldosteronism in treatment and disease (cardiovascular disease and stroke) naive hypertensive patients. Within the model, a 40-year-old patient with hypertension went through either the screened or the unscreened arm of the model. They were followed until age 80 or death. In the screening arm, the patient underwent standard diagnostic testing for primary aldosteronism if the screening test, aldosterone-to-renin ratio, was elevated above 70 pmol/l: mU/l. Diagnostic accuracies, transition probabilities and costs were derived from published literature and expert advice. The main outcome of interest was the incremental cost effectiveness ratio (ICER).Results:Screening hypertensive patients for primary aldosteronism compared with not screening attained an ICER of AU$35 950.44 per quality-adjusted life year (QALY) gained. The results were robust to different sensitivity analyses. Probabilistic sensitivity analysis demonstrated that in 73% of the cases, it was cost-effective to screen at the commonly adopted willingness-to-pay (WTP) threshold of AU$50 000.Conclusion:The results from this study demonstrated that screening all hypertensive patients for primary aldosteronism from age 40 is cost-effective. The findings argue in favour of screening for primary aldosteronism before the development of severe hypertension in the Australian healthcare setting. 2023 Journal Article http://hdl.handle.net/20.500.11937/93777 10.1097/HJH.0000000000003513 eng http://purl.org/au-research/grants/nhmrc/1184927 restricted |
| spellingShingle | Humans Aged, 80 and over Adult Cost-Benefit Analysis Australia Hypertension Hyperaldosteronism Quality-Adjusted Life Years Markov Chains Humans Hypertension Hyperaldosteronism Markov Chains Quality-Adjusted Life Years Adult Aged, 80 and over Cost-Benefit Analysis Australia Woode, M.E. Wong, K. Reid, Christopher Stowasser, M. Russell, G. Gwini, S. Young, M.J. Fuller, P.J. Yang, J. Chen, G. Cost-effectiveness of screening for primary aldosteronism in hypertensive patients in Australia: A Markov modelling analysis |
| title | Cost-effectiveness of screening for primary aldosteronism in hypertensive patients in Australia: A Markov modelling analysis |
| title_full | Cost-effectiveness of screening for primary aldosteronism in hypertensive patients in Australia: A Markov modelling analysis |
| title_fullStr | Cost-effectiveness of screening for primary aldosteronism in hypertensive patients in Australia: A Markov modelling analysis |
| title_full_unstemmed | Cost-effectiveness of screening for primary aldosteronism in hypertensive patients in Australia: A Markov modelling analysis |
| title_short | Cost-effectiveness of screening for primary aldosteronism in hypertensive patients in Australia: A Markov modelling analysis |
| title_sort | cost-effectiveness of screening for primary aldosteronism in hypertensive patients in australia: a markov modelling analysis |
| topic | Humans Aged, 80 and over Adult Cost-Benefit Analysis Australia Hypertension Hyperaldosteronism Quality-Adjusted Life Years Markov Chains Humans Hypertension Hyperaldosteronism Markov Chains Quality-Adjusted Life Years Adult Aged, 80 and over Cost-Benefit Analysis Australia |
| url | http://purl.org/au-research/grants/nhmrc/1184927 http://hdl.handle.net/20.500.11937/93777 |