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首页> 外文期刊>Hormone and Metabolic Research >Cost-Effectiveness Analysis of the Diagnosis and Treatment of Primary Aldosteronism in Japan
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Cost-Effectiveness Analysis of the Diagnosis and Treatment of Primary Aldosteronism in Japan

机译：日本原发性醛固酮增多症的诊​​治成本效益分析

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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.
机译：在日本，约有10％的高血压病例是由原发性醛固酮增多症（PA）引起的，总计约400万患者。单侧醛固酮分泌过多引起的原发性醛固酮增多症可通过肾上腺切除术治愈。鉴定和治疗PA的临床益处已在国际上报道，但其成本效益尚不清楚。我们检查了与不理想的治疗相比，诊断和治疗高血压人群的隐匿性PA是否具有成本效益。我们的假设患者是一名50岁的男性，被诊断患有I-III期高血压。我们基于合理的临床途径和PA的预后建立了Markov决策模型。我们进行了成本效益分析，比较了针对PA的综合诊断策略（血浆醛固酮/肾素比的测量，两次负荷试验，成像和选择性的肾上腺静脉采样）与次优策略（通过药物来控制高血压），除非PA的典型征兆或其他并发症也很明显。结果指标是预期成本，预期效果和增量成本效益比。结果的稳健性是通过单向和情景敏感性分析确定的。与标准治疗相比，全面的PA诊断策略使预期成本增加了64 004日元，预期寿命延长了0.013日元。每年用于诊断PA的成本效益比为4 923 385日元。我们的发现对筛查和治疗的结果，持续或定期治疗高血压以及中风及其并发症的治疗费用敏感。

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