Cost-Effectiveness of Therapeutic Drug Monitoring in Diagnosing Primary Aldosteronism in Patients With Resistant Hypertension

Alejandro Velasco, Oliver Chung, Fayez Raza, Ambarish Pandey, Stephanie K Brinker, Debbie Arbique, Angela L Price, Yair Lotan, Sandeep R Das, Wanpen Vongpatanasin

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)713-719
Number of pages7
JournalJournal of clinical hypertension
Volume17
Issue number9
DOIs
StatePublished - Sep 1 2015

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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