Screening for primary aldosteronism in the hypertensive OSA
Guidelines recommend screening for primary aldosteronism in patients diagnosed with hypertension and obstructive sleep apnea.

Investigators constructed a decision-analytic model to evaluate screening of the hypertensive obstructive sleep apnea population for primary aldosteronism as per guideline recommendations in comparison with current rates of screening.

Probabilities, utility values, and costs were identified in the literature. Threshold and sensitivity analyses assessed the robustness of the model. Costs were represented in 2020 US dollars and health outcomes in quality-adjusted life-years. The model assumed a societal perspective with a lifetime time horizon.

- Screening per guideline recommendations had an expected cost of $47,016 and 35.27 quality-adjusted life-years. Continuing at current rates of screening had an expected cost of $48,350 and 34.86 quality-adjusted life-years.

- The screening was dominant, as it was both less costly and more effective.

- These results were robust to sensitivity analysis of disease prevalence, test sensitivity, patient age, and expected outcome of medical or surgical treatment of primary aldosteronism.

- The screening strategy remained cost-effective even if screening was conservatively presumed to identify only 3% of new primary aldosteronism cases.

In particular, for patients with hypertension and obstructive sleep apnea, rigorous screening for primary aldosteronism is cost-saving due to cardiovascular risk averted. Cost should not be a barrier to improving primary aldosteronism screening adherence.

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