Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients.
Cost-Effectiveness of Screening for Primary Aldosteronism and Subtype Diagnosis in the Resistant Hypertensive Patients.
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DOI：
10.1161/circoutcomes.115.002002
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发表时间：
2015-11
期刊：
影响因子：
--
通讯作者：
Gaziano TA
中科院分区：
文献类型：
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作者：
Lubitz CC;Economopoulos KP;Sy S;Johanson C;Kunzel HE;Reincke M;Gazelle GS;Weinstein MC;Gaziano TA
原发性醛固酮增多症（PA）是一种常见的和诊断不足的疾病，具有显着的发病率可能通过手术治愈。我们的目的是评估在患者被诊断为顽固性高血压（RH）时，识别和治疗可手术纠正的PA的长期心血管益处是否超过患者的前期增加成本。一个决策分析模型比较了总成本和收缩压（SBP）的变化，六个推荐或实施的诊断策略PA在一个模拟的人群中的风险RH患者。我们还评估了第七个“治疗所有”的策略，其中所有的RH患者与盐皮质激素受体拮抗剂治疗，在RH诊断没有进一步的测试。SBP的变化随后通过将国家健康和营养检查调查的伴随风险因素数据应用于现有的心血管疾病模拟模型，转换为质量调整生命年（QELS）的收益。然后，使用QELS和寿命成本来计算竞争策略的增量成本效益比（ICER）。与“全部治疗”相比，计算机断层扫描（CT）后肾上腺静脉采样（AVS）策略的ICER为82，000美元/QALY。单独CT和单独AVS的ICER分别为200，000美元/QALY和492，000美元/QALY;其他策略成本更高，效果更差。整合PA患者的不同患者报告的健康相关生活质量调整，筛选CT后AVS、单独CT和单独AVS患者的ICER分别为52，000美元/QALY、114，000美元/QALY和269，000美元/QALY。CT扫描后AVS是筛查顽固性高血压患者PA的一种成本效益高的策略。
Primary aldosteronism (PA) is a common and under-diagnosed disease with significant morbidity potentially cured by surgery. We aim to assess if the long-term cardiovascular benefits of identifying and treating surgically correctable PA outweigh the upfront increased costs in patients at the time patients are diagnosed with resistant hypertension (RH). A decision-analytic model compares aggregate costs and systolic blood pressure (SBP) changes of six recommended or implemented diagnostic strategies for PA in a simulated population of at-risk RH patients. We also evaluate a seventh “treat all” strategy wherein all patients with RH are treated with a mineralocorticoid-receptor antagonist without further testing at RH diagnosis. Changes in SBP are subsequently converted into gains in quality-adjusted life years (QALYs) by applying National Health and Nutrition Examination Survey data on concomitant risk factors to an existing cardiovascular disease simulation model. QALYs and lifetime costs were then used to calculate incremental cost-effectiveness ratios (ICERs) for the competing strategies. The ICER for the strategy of computerized tomography (CT) followed by adrenal venous sampling (AVS) was $82,000/QALY compared to “treat all”. ICERs for CT alone and AVS alone were $200,000/QALY and $492,000/QALY; the other strategies were more costly and less effective. Integrating differential patient-reported health-related quality of life adjustments for patients with PA, ICERs for screening patients with CT followed by AVS, CT alone, and AVS alone were $52,000/QALY, $114,000/QALY, and $269,000/QALY gained. CT scanning followed by AVS was a cost-effective strategy to screen for PA among patients with resistant hypertension.