Evaluating the cost-effectiveness of different strategies for the diagnosis and management of primary aldosteronism

Primary aldosteronism (PA) is the most common, and a potentially curable, cause of hypertension, estimated to affect 5-10% of all hypertensive patients. It leads to greater cardiovascular injury than hypertension alone. Studies have demonstrated the cost-effectiveness of screening patients with resistant hypertension for PA, but there are no economic modelling studies of screening newly diagnosed hypertensive patients. An early diagnosis is likely to be less complicated for a patient than long-standing disease, and offer greater benefit in reducing cardiovascular risk. Furthermore, there may be strategies to reduce the number of diagnostic tests required prior to the treatment of PA for these patients. However, without a formal cost analysis, hypertension diagnostic guidelines will remain locked in the past to the detriment of our community. This project will use the cost-utility analysis (CUA) approach to estimate the incremental costs and effectiveness of using various strategies to screen, diagnose and subtype PA. The within-trial analysis will be extrapolated using a Markov model to capture the long-term cost of the various strategies. The estimates of the effect on long-run health outcomes, quality of life and costs (such as cost savings of cardiovascular events averted) will be made from a comprehensive literature review.