Horm Metab Res 2015; 47(11): 826-832
DOI: 10.1055/s-0035-1559645
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Cost-Effectiveness Analysis of the Diagnosis and Treatment of Primary Aldosteronism in Japan

M. Sato
1   Division of Clinical Imaging, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
,
R. Morimoto
2   Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
,
K. Seiji
3   Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
,
Y. Iwakura
2   Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
,
Y. Ono
2   Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
,
M. Kudo
2   Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
,
F. Satoh
2   Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
4   Division of Clinical Hypertension, Endocrinology and Metabolism, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
,
S. Ito
2   Division of Nephrology, Endocrinology and Vascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
,
T. Ishibashi
1   Division of Clinical Imaging, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
,
K. Takase
3   Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
› Author Affiliations
Further Information

Publication History

received 24 January 2015

accepted 14 July 2015

Publication Date:
25 August 2015 (online)

Abstract

Approximately 10% of cases of hypertension in Japan are caused by primary aldosteronism (PA), amounting to about 4 million patients in total. Primary aldosteronism due to unilateral aldosterone hypersecretion is potentially curable by adrenalectomy. The clinical benefits of identifying and treating PA have been reported internationally, but its cost-effectiveness is unclear. We examined whether diagnosing and treating hidden PA in hypertensive population was cost-effective compared with suboptimal treatment. Our hypothetical patient was a 50-year-old man diagnosed with stage I–III hypertension. We established a Markov decision model based on plausible clinical pathways and prognoses of PA. We applied cost-effectiveness analysis comparing a comprehensive diagnostic strategy for PA (measurement of plasma aldosterone/renin ratio, 2 loading tests, imaging, and selective adrenal venous sampling) with a suboptimal strategy to manage hypertension by medication unless the typical signs of PA or other complication were manifest. Outcome measures were expected costs, expected effectiveness, and incremental cost-effectiveness ratio. The robustness of the findings was established by one-way and scenario sensitivity analyses. The comprehensive PA diagnostic strategy increased the expected costs by 64 004 JPY and expected life-years by 0.013 compared with standard treatment. The incremental cost-effectiveness ratio for the diagnosis of PA was 4 923 385 JPY per year. Our findings were sensitive to the outcomes of screening and treatment, and the costs of continuous or periodic medication for hypertension and the treatment of stroke and its complications.

 
  • References

  • 1 Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903-1913
  • 2 Ministry of Health, labour and Welfare. National Health and Nutrition Examination Survey. Available from http://www.mhlw.go.jp/houdou/2008/04/h0430-2a.html [Accessed October 15, 2013]
  • 3 Ministry of Health, labour and Welfare. National Health Expenditure. Available from http://www.mhlw.go.jp/toukei/list/37-21.html [Accessed October 15, 2013]
  • 4 Gordon RD, Stowasser M, Tunny TJ, Klemm SA, Rutherford JC. High incidence of primary aldosteronism in 199 patients referred with hypertension. Clin Exp Pharmacol Physiol 1994; 21: 315-318
  • 5 Lim PO, Dow E, Brennan G, Jung RT, MacDonald TM. High prevalence of primary aldosteronism in the Tayside hypertension clinic population. J Hum Hypertens 2000; 14: 311-315
  • 6 Loh KC, Koay ES, Khaw MC, Emmanuel SC, Young Jr WF. Prevalence of primary aldosteronism among Asian hypertensive patients in Singapore. J Clin Endocrinol Metab 2000; 85: 2854-2859
  • 7 Mulatero P, Monticone S, Veglio F. Diagnosis and treatment of primary aldosteronism. Rev Endocr Metab Disord 2011; 12: 3-9
  • 8 Rossi E, Regolisti G, Negro A, Sani C, Davoli S, Perazzoli F. High prevalence of primary aldosteronism using postcaptopril plasma aldosterone to renin ratio as a screening test among Italian hypertensives. AM J Hypertens 2002; 15: 896-902
  • 9 Nishikawa T, Omura M. Clinical characteristics of primary aldosteronism: its prevalence and comparative studies on various causes of primary aldosteronism in Yokohama Rosai Hospital. Biomed Pharmacother 2000; 54: 83-85
  • 10 Fardella CE, Mosso L, Gómez-Sánchez C, Cortés P, Soto J, Gómez L, Pinto M, Huete A, Oestreicher E, Foradori A, Montero J. Primary hyperaldosteronism in essential hypertensives: prevalence, biochemical profile, and molecular biology. J Clin Endocrinol Metab 2000; 85: 1863-1867
  • 11 Strauch B, Zelinka T, Hampf M, Bernhardt R, Widimsky Jr J. Prevalence of primary hyperaldosteronism in moderate to severe hypertension in the Central Europe region. J Hum Hypertens 2003; 17: 349-352
  • 12 Williams JS, Williams GH, Raji A, Jeunemaitre X, Brown NJ, Hopkins PN, Conlin PR. Prevalence of primary hyperaldosteronism in mild to moderate hypertension without hypokalaemia. J Hum Hypertens 2006; 20: 129-136
  • 13 Omura M, Saito J, Yamaguchi K, Kakuta Y, Nishikawa T. Prospective study on the prevalence of secondary hypertension among hypertensive patients visiting a general outpatient clinic in Japan. Hypertens Res 2004; 27: 193-202
  • 14 Sawka AM, Young WF, Thompson GB, Grant CS, Farley DR, Leibson C, van Heerden JA. Primary aldosteronism: factors associated with normalization of blood pressure after surgery. Ann Intern Med 2001; 135: 258-261
  • 15 Fukudome Y, Fujii K, Arima H, Ohya Y, Tsuchihashi T, Abe I, Fujishima M. Discriminating factors for recurrent hypertension in patients with primary aldosteronism after adrenalectomy. Hypertens Res 2002; 25: 11-18
  • 16 Rossi H, Kim A, Prinz RA. Primary hyperaldosteronism in the era of laparoscopic adrenalectomy. AM Surgeon 2002; 68: 256-257
  • 17 Nakajima Y, Yamada M, Taguchi R, Satoh T, Hashimoto K, Ozawa A, Shibusawa N, Okada S, Monden T, Mori M. Cardiovascular complications of patients with aldosteronism associated with autonomous cortisol secretion. J Clin Endocrinol Metab 2011; 96: 2512-2518
  • 18 Milliez P, Girerd X, Plouin PF, Blacher J, Safar ME, Mourad JJ. Evidence for an increased rate of cardiovascular events in patients with primary aldosteronism. J Am Coll Cardiol 2005; 45: 1243-1248
  • 19 Yoshimoto T, Hirata Y. Aldosterone as a cardiovascular risk hormone. Endocr J 2007; 54: 359-370
  • 20 The Japan Endocrine Society . The guideline for primary aldosteronism diagnosis and treatment 2009. Endocr J 2010; 86: 1-19
  • 21 Nishikawa T, Omura M, Satoh F, Shibata H, Takahashi K, Tamura N, Tanabe A. Task Force Committee on Primary Aldosteronism, The Japan Endocrine Society . Guidelines for the diagnosis and treatment of primary aldosteronism–the Japan Endocrine Society 2009. Endocr J 2011; 58: 711-721
  • 22 The Japanese Society of Hypertension . Guideline for the Management of Hypertension JSH 2009. Tokyo: Life Science co., Ltd; 2009
  • 23 Satoh F, Abe T, Tanemoto M, Nakamura M, Abe M, Uruno A, Morimoto R, Sato A, Takase K, Ishidoya S, Arai Y, Suzuki T, Sasano H, Ishibashi T, Ito S. Localization of aldosterone-producing adrenocortical adenomas: significance of adrenal venous sampling. Hypertens Res 2007; 30: 1083-1095
  • 24 Ishibashi T, Satoh F, Yamada T, Sato A, Matsuhashi T, Takase K. Primary aldosteronism: a pictorial essay. Abdom Imaging 2007; 32: 504-514
  • 25 Ishidoya S, Ito A, Sakai K, Satoh M, Chiba Y, Sato F, Arai Y. Laparoscopic partial versus total adrenalectomy for aldosterone producing adenoma. J Urol 2005; 174: 40-43
  • 26 Satoh F, Morimoto R, Iwakura Y, Ono Y, Kudo M, Takase K, Ito S. Primary aldosteronism: A Japanese perspective. Rev Endocr Metab Disord 2011; 12: 11-14
  • 27 Ishidoya S, Kaiho Y, Ito A, Morimoto R, Satoh F, Ito S, Ishibashi T, Nakamura Y, Sasano H, Arai Y. Single-center outcome of laparoscopic unilateral adrenalectomy for patients with primary aldosteronism: lateralizing disease using results of adrenal venous sampling. Urology 2011; 78: 68-73
  • 28 Young Jr WF. Primary aldosteronism: management issues. Ann NY Acad Sci 2002; 970: 61-76
  • 29 Mosso L, Carvajal C, González A, Barraza A, Avila F, Montero J, Huete A, Gederlini A, Fardella CE. Primary aldosteronism and hypertensive disease. Hypertension 2003; 42: 161-165
  • 30 Ceral J, Malirova E, Ballon M, Solar M. The Role of Urinary Aldosterone for the Diagnosis of Primary Aldosteronism. Horm Metab Res 2014; 46: 663-667
  • 31 Pilz S, Kienreich K, Gaksch M, Grübler M, Verheyen N, Bersuch LA, Schmid J, Drechsler C, Ritz E, Moosbrugger A, Stepan V, Pieber TR, Meinitzer A, März W, Tomaschitz A. Aldosterone to Active Renin Ratio as Screening Test for Primary Aldosteronism: Reproducibility and Influence of Orthostasis and Salt Loading. Horm Metab Res 2014; 46: 427-432
  • 32 Fischer E, Reuschl S, Quinkler M, Rump LC, Hahner S, Bidlingmaier M, Reincke M. Assay characteristics influence the aldosterone to renin ratio as a screening tool for primary aldosteronism: results of the German Conn’s registry. Horm Metab Res 2013; 45: 526-531
  • 33 The guideline of socio-economic evaluation for Medical Technology. Ministry of Economy, Trade and Industry in Japan. 2007: 11
  • 34 Imano H, Kitamura A, Sato S, Kiyama M, Ohira T, Yamagishi K, Noda H, Tanigawa T, Iso H, Shimamoto T. Trends for blood pressure and its contribution to stroke incidence in the ddle-aged Japanese population: the Circulatory Risk in Communities Study (CIRCS). Stroke 2009; 40: 1571-1577
  • 35 Ministry of Health, labour and Welfare. Life Table. Available from http://www.mhlw.go.jp/toukei/list/list54-57.html [Accessed January 1, 2012]
  • 36 Schwartz GL. Screening for adrenal-endocrine hypertension: overview of accuracy and cost-effectiveness. Endocrinol Metab Clin North Am 2011; 40: 279-294
  • 37 Sywak M, Pasieka JL. Long-term follow-up and cost benefit of adrenalectomy in patients with primary hyperaldosteronism. Brit J Surg 2002; 89: 1587-1593
  • 38 Ohkusa Y, Sugawara T. Research for Willingness to pay for One QALY Gain. Iryou to Syakai 2006; 16: 9
  • 39 Catena 1 C, Colussi G, Nadalini E, Chiuch A, Baroselli S, Lapenna R, Sechi LA. Cardiovascular outcomes in patients with primary aldosteronism after treatment. Arch Intern Med 2008; 168: 80-85
  • 40 Catena 1 C, Colussi G, Lapenna R, Nadalini E, Chiuch A, Gianfagna P, Sechi LA. Long-term cardiac effects of adrenalectomy or mineralocorticoid antagonists in patients with primary aldosteronism. Hypertension 2007; 50: 911-918
  • 41 Rossi GP, Bernini G, Desideri G, Fabris B, Ferri C, Giacchetti G, Letizia C, Maccario M, Mannelli M, Matterello MJ, Montemurro D, Palumbo G, Rizzoni D, Rossi E, Pessina AC, Mantero F. PAPY Study Participants . PAPY Study Participants. Renal damage in primary aldosteronism: results of the PAPY Study. Hypertension 2006; 48: 232-238
  • 42 Proye CA, Mulliez EA, Carnaille BM, Lecomte-Houcke M, Decoulx M, Wémeau JL, Lefebvre J, Racadot A, Ernst O, Huglo D, Carré A. Essential hypertension: first reason for persistent hypertension after unilateral adrenalectomy for primary aldosteronism?. Surgery 1998; 124: 1128-1133