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 journalArticlepeer-review

19 Scopus citations

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

ASJC Scopus subject areas

  • Surgery

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