Cost-effectiveness Analysis of Screening for Primary Aldosteronism in China.

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.