Cost-Effectiveness of Therapeutic Drug Monitoring in Diagnosing Primary Aldosteronism in Patients With Resistant Hypertension.
Cost-Effectiveness of Therapeutic Drug Monitoring in Diagnosing Primary Aldosteronism in Patients With Resistant Hypertension.
复制标题
DOI：
10.1111/jch.12570
复制
发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Vongpatanasin W
中科院分区：
文献类型：
--
作者：
Velasco A;Chung O;Raza F;Pandey A;Brinker S;Arbique D;Price A;Lotan Y;Das SR;Vongpatanasin W
原发性醛固酮增多症（PA）存在于高达20%的难治性高血压（TRH）患者中。现行指南建议在排除药物不依从性后，对TRH患者进行PA检查。使用治疗药物监测（TDM）的研究表明，超过50%的TRH患者不遵守他们的处方降压药物。然而，PA的患病率和药物依从性之间的关系，如TDM证实，以前没有进行评估。一项来自我们高血压转诊门诊的回顾性分析显示，经TDM检测，依从TRH患者的PA患病率显著高于未依从患者（28% vs.8%，p<0.05）。此外，成本分析显示，TDM引导的PA筛查每例患者的成本降低了590.69美元，对诊断准确性的影响最小。我们的数据支持TDM引导的PA筛查方法作为TRH常规PA筛查相比节省成本的策略。
Primary aldosteronism (PA) is present in up to 20% of patients with treatment resistant hypertension (TRH). Investigation for PA in TRH is recommended by the current guidelines after medication nonadherence is excluded. Studies using therapeutic drug monitoring (TDM) have shown more than 50% of patients with TRH are nonadherent to their prescribed antihypertensive medications. However, the relationship between the prevalence of PA and medication adherence as confirmed by TDM has not been previously assessed. A retrospective analysis from our hypertension referral clinic showed that prevalence of PA in adherent TRH patients by TDM was significantly higher than in nonadherent patients (28% vs. 8%, p<0.05). Furthermore, a cost analysis showed that TDM-guided PA screening was $590.69 less expensive per patient, with minimal impact on the diagnostic accuracy. Our data supports a TDM-guided PA screening approach as a cost saving strategy compared to routine PA screening for TRH.