Cost-Effectiveness of Therapeutic Drug Monitoring in Diagnosing Primary Aldosteronism in Patients With Resistant Hypertension.
Primary aldosteronism (PA) is present in up to 20% of patients with treatment-resistant hypertension (TRH). Investigation for PA in patients with TRH is recommended by current guidelines after medication nonadherence is excluded. Studies using therapeutic drug monitoring (TDM) have shown that >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 a hypertension referral clinic showed that prevalence of PA in adherent patients with TRH by TDM was significantly higher than in nonadherent patients (28% vs 8%, P<.05). Furthermore, cost analysis showed that TDM-guided PA screening was $590.69 less expensive per patient, with minimal impact on the diagnostic accuracy. These data support a TDM-guided PA screening approach as a cost-saving strategy compared with routine PA screening for TRH.
Hypertension Section, University of Texas Southwestern Medical Center, Dallas, TX.
Alejandro
A
Velasco
Department of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Oliver
O
Chung
Internal Medicine Department, University of Texas Southwestern Medical Center, Dallas, TX.
Fayez
F
Raza
Internal Medicine Department, University of Texas Southwestern Medical Center, Dallas, TX.|Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX.
Ambarish
A
Pandey
Internal Medicine Department, University of Texas Southwestern Medical Center, Dallas, TX.
Stephanie
S
Brinker
Hypertension Section, University of Texas Southwestern Medical Center, Dallas, TX.
Debbie
D
Arbique
Hypertension Section, University of Texas Southwestern Medical Center, Dallas, TX.|Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX.
Angela
A
Price
Urology Department, University of Texas Southwestern Medical Center, Dallas, TX.
Yair
Y
Lotan
Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX.
Sandeep R
SR
Das
Hypertension Section, University of Texas Southwestern Medical Center, Dallas, TX.|Cardiology Division, University of Texas Southwestern Medical Center, Dallas, TX.
Wanpen
W
Vongpatanasin
D000450:Aldosterone / Q000097:blood; D000959:Antihypertensive Agents / Q000191:economics / Q000627:therapeutic use; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D003362:Cost-Benefit Analysis / Q000379:methods; D003661:Decision Support Techniques; D016903:Drug Monitoring / Q000191:economics*; D004351:Drug Resistance; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D006929:Hyperaldosteronism / Q000097:blood / Q000175:diagnosis* / Q000191:economics*; D006973:Hypertension / Q000097:blood* / Q000188:drug therapy* / Q000191:economics; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015995:Prevalence; D012083:Renin / Q000097:blood; D012189:Retrospective Studies
D000959:Antihypertensive Agents; D000450:Aldosterone; D012083:Renin