Screening for the alpha-adducin Gly460Trp variant in hypertensive patients: a cost-effectiveness analysis.
BACKGROUND
Studies have shown that approximately 80% of hypertensive patients do not take diuretics despite their recommendation as a first-line therapy. A recent study reported that hypertensive patients with the Gly460Trp variant in the alpha-adducin gene are more likely to benefit from diuretic therapy. The objective of this study was to evaluate the potential cost effectiveness of screening for the alpha-adducin Gly460Trp variant among hypertensive patients.


METHODS
A decision analytic Markov model was developed to estimate the clinical and economic outcomes comparing screening for the Gly460Trp variant to identify patients for addition of a diuretic compared to no screening and no addition of diuretic (usual care) in a hypothetical cohort of treated hypertensive patients not receiving diuretic therapy. We used a lifetime horizon and payer perspective. Cost, utility and epidemiological data were obtained from the literature. One-way, probabilistic, and scenario sensitivity analyses were conducted to evaluate the uncertainty in the results.


RESULTS
The screening strategy increased quality adjusted life years (QALYs) by 0.14 (95% confidence range [CR]: 0.05, 0.36) and saved dollar 1834 (dollar 505, dollar 5174) compared to usual care. The most influential input was the strength of the interaction between the alpha-adducin gene variant and diuretic effect.


CONCLUSIONS
Our results suggest that screening for the alpha-adducin gene variant may be a useful mechanism to identify patients most likely to benefit from diuretic therapy and improve compliance with current treatment guidelines.
Meckley
Lisa M
LM
University of Washington, Seattle WA 98195-7630, USA. lmeckley@u.washington.edu
Veenstra
David L
DL
D000368:Aged; D002148:Calmodulin-Binding Proteins / Q000235:genetics*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004232:Diuretics / Q000494:pharmacology; D005260:Female; D005820:Genetic Testing / Q000191:economics* / Q000379:methods*; D014644:Genetic Variation; D006801:Humans; D006973:Hypertension / Q000235:genetics*; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000379:methods; D016017:Odds Ratio; D010597:Pharmacogenetics / Q000379:methods*; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D000099291:Adducins
D002148:Calmodulin-Binding Proteins; D004232:Diuretics; D000099291:Adducins