The management of aldosterone-producing adrenal adenomas - Does adrenalectomy increase costs?

Bethann Reimel, Kyle Zanocco, Mark J. Russo, Rasa Zarnegar, Orlo H. Clark, John D. Allendorf, John A. Chabot, Quan Yang Duh, James A. Lee, Cord Sturgeon*

*Corresponding author for this work

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Most experts agree that primary hyperaldosteronism (PHA) caused by an aldosterone-producing adenoma (APA) is best treated by adrenalectomy. From a public health standpoint, the cost of treatment must be considered. We sought to compare the current guideline-based (surgical) strategy with universal pharmacologic management to determine the optimal strategy from a cost perspective. Methods: A decision analysis was performed using a Markov state transition model comparing the strategies for PHA treatment. Pharmacologic management for all patients with PHA was compared with a strategy of screening for and resecting an aldosterone-producing adenoma. Success rates were determined for treatment outcomes based on a literature review. Medicare reimbursement rates were calculated to estimate costs from a third-party payer perspective. Results: Screening for and resecting APAs was the least costly strategy in this model. For a reference patient with 41 remaining years of life, the discounted expected cost of the surgical strategy was $27,821. The discounted expected cost of the medical strategy was $34,691. The cost of adrenalectomy would have to increase by 156% to $22,525 from $8,784 for universal pharmacologic therapy to be less costly. Screening for APA is more costly if fewer than 9.6% of PHA patients have resectable APA. Conclusion: Resection of APAs was the least costly treatment strategy in this decision analysis model.

Original languageEnglish (US)
Pages (from-to)1178-1185
Number of pages8
JournalSurgery
Volume148
Issue number6
DOIs
StatePublished - Dec 1 2010

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Adrenalectomy
Aldosterone
Hyperaldosteronism
Adenoma
Costs and Cost Analysis
Decision Support Techniques
Health Insurance Reimbursement
Medicare
Health Care Costs
Therapeutics
Public Health
Guidelines

ASJC Scopus subject areas

  • Surgery

Cite this

Reimel, B., Zanocco, K., Russo, M. J., Zarnegar, R., Clark, O. H., Allendorf, J. D., ... Sturgeon, C. (2010). The management of aldosterone-producing adrenal adenomas - Does adrenalectomy increase costs? Surgery, 148(6), 1178-1185. https://doi.org/10.1016/j.surg.2010.09.012
Reimel, Bethann ; Zanocco, Kyle ; Russo, Mark J. ; Zarnegar, Rasa ; Clark, Orlo H. ; Allendorf, John D. ; Chabot, John A. ; Duh, Quan Yang ; Lee, James A. ; Sturgeon, Cord. / The management of aldosterone-producing adrenal adenomas - Does adrenalectomy increase costs?. In: Surgery. 2010 ; Vol. 148, No. 6. pp. 1178-1185.
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abstract = "Background: Most experts agree that primary hyperaldosteronism (PHA) caused by an aldosterone-producing adenoma (APA) is best treated by adrenalectomy. From a public health standpoint, the cost of treatment must be considered. We sought to compare the current guideline-based (surgical) strategy with universal pharmacologic management to determine the optimal strategy from a cost perspective. Methods: A decision analysis was performed using a Markov state transition model comparing the strategies for PHA treatment. Pharmacologic management for all patients with PHA was compared with a strategy of screening for and resecting an aldosterone-producing adenoma. Success rates were determined for treatment outcomes based on a literature review. Medicare reimbursement rates were calculated to estimate costs from a third-party payer perspective. Results: Screening for and resecting APAs was the least costly strategy in this model. For a reference patient with 41 remaining years of life, the discounted expected cost of the surgical strategy was $27,821. The discounted expected cost of the medical strategy was $34,691. The cost of adrenalectomy would have to increase by 156{\%} to $22,525 from $8,784 for universal pharmacologic therapy to be less costly. Screening for APA is more costly if fewer than 9.6{\%} of PHA patients have resectable APA. Conclusion: Resection of APAs was the least costly treatment strategy in this decision analysis model.",
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Reimel, B, Zanocco, K, Russo, MJ, Zarnegar, R, Clark, OH, Allendorf, JD, Chabot, JA, Duh, QY, Lee, JA & Sturgeon, C 2010, 'The management of aldosterone-producing adrenal adenomas - Does adrenalectomy increase costs?', Surgery, vol. 148, no. 6, pp. 1178-1185. https://doi.org/10.1016/j.surg.2010.09.012

The management of aldosterone-producing adrenal adenomas - Does adrenalectomy increase costs? / Reimel, Bethann; Zanocco, Kyle; Russo, Mark J.; Zarnegar, Rasa; Clark, Orlo H.; Allendorf, John D.; Chabot, John A.; Duh, Quan Yang; Lee, James A.; Sturgeon, Cord.

In: Surgery, Vol. 148, No. 6, 01.12.2010, p. 1178-1185.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The management of aldosterone-producing adrenal adenomas - Does adrenalectomy increase costs?

AU - Reimel, Bethann

AU - Zanocco, Kyle

AU - Russo, Mark J.

AU - Zarnegar, Rasa

AU - Clark, Orlo H.

AU - Allendorf, John D.

AU - Chabot, John A.

AU - Duh, Quan Yang

AU - Lee, James A.

AU - Sturgeon, Cord

PY - 2010/12/1

Y1 - 2010/12/1

N2 - Background: Most experts agree that primary hyperaldosteronism (PHA) caused by an aldosterone-producing adenoma (APA) is best treated by adrenalectomy. From a public health standpoint, the cost of treatment must be considered. We sought to compare the current guideline-based (surgical) strategy with universal pharmacologic management to determine the optimal strategy from a cost perspective. Methods: A decision analysis was performed using a Markov state transition model comparing the strategies for PHA treatment. Pharmacologic management for all patients with PHA was compared with a strategy of screening for and resecting an aldosterone-producing adenoma. Success rates were determined for treatment outcomes based on a literature review. Medicare reimbursement rates were calculated to estimate costs from a third-party payer perspective. Results: Screening for and resecting APAs was the least costly strategy in this model. For a reference patient with 41 remaining years of life, the discounted expected cost of the surgical strategy was $27,821. The discounted expected cost of the medical strategy was $34,691. The cost of adrenalectomy would have to increase by 156% to $22,525 from $8,784 for universal pharmacologic therapy to be less costly. Screening for APA is more costly if fewer than 9.6% of PHA patients have resectable APA. Conclusion: Resection of APAs was the least costly treatment strategy in this decision analysis model.

AB - Background: Most experts agree that primary hyperaldosteronism (PHA) caused by an aldosterone-producing adenoma (APA) is best treated by adrenalectomy. From a public health standpoint, the cost of treatment must be considered. We sought to compare the current guideline-based (surgical) strategy with universal pharmacologic management to determine the optimal strategy from a cost perspective. Methods: A decision analysis was performed using a Markov state transition model comparing the strategies for PHA treatment. Pharmacologic management for all patients with PHA was compared with a strategy of screening for and resecting an aldosterone-producing adenoma. Success rates were determined for treatment outcomes based on a literature review. Medicare reimbursement rates were calculated to estimate costs from a third-party payer perspective. Results: Screening for and resecting APAs was the least costly strategy in this model. For a reference patient with 41 remaining years of life, the discounted expected cost of the surgical strategy was $27,821. The discounted expected cost of the medical strategy was $34,691. The cost of adrenalectomy would have to increase by 156% to $22,525 from $8,784 for universal pharmacologic therapy to be less costly. Screening for APA is more costly if fewer than 9.6% of PHA patients have resectable APA. Conclusion: Resection of APAs was the least costly treatment strategy in this decision analysis model.

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Reimel B, Zanocco K, Russo MJ, Zarnegar R, Clark OH, Allendorf JD et al. The management of aldosterone-producing adrenal adenomas - Does adrenalectomy increase costs? Surgery. 2010 Dec 1;148(6):1178-1185. https://doi.org/10.1016/j.surg.2010.09.012