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. 2025 Feb;43(2):290-300.
doi: 10.1007/s11604-024-01665-6. Epub 2024 Sep 25.

Cost-effectiveness analysis of segmental adrenal venous sampling with radiofrequency ablation for primary aldosteronism in Japan

Satoru Yanagaki  1   2 , Kei Omata  3   4 , Sota Oguro  5 , Hideki Ota  5 , Tomomi Sato  5   6 , Hiroki Kamada  5 , Hiromitsu Tannai  5 , Yuta Tezuka  3   4 , Yoshikiyo Ono  3   4 , Miho Sato  7 , Hiroyuki Ohbe  8 , Kei Takase  5
Affiliations

Cost-effectiveness analysis of segmental adrenal venous sampling with radiofrequency ablation for primary aldosteronism in Japan

Satoru Yanagaki et al. Jpn J Radiol. 2025 Feb.

Abstract

Purpose: The purpose of this study was to evaluate the cost-effectiveness of comprehensive treatment strategy, including segmental adrenal venous sampling (sAVS) and radiofrequency ablation (RFA), versus medication-only strategy for primary aldosteronism.

Materials and methods: A Markov decision model was developed to compare the cost-effectiveness of a comprehensive treatment strategy and a medication-only strategy for 50-year-old men and women with stage I-III hypertension. The comprehensive treatment strategy included aldosterone/renin ratio measurement, two loading tests, computed tomography, sAVS, drugs, surgery, and RFA. We built a model with a yearly cycle over 32- and 38-year time horizons for men and women, respectively, and four health states: hypertension, heart failure, stroke, and death. The incremental cost-effectiveness ratio (ICER), expressed as Japanese yen per quality-adjusted life-years (QALYs), was estimated, and strategy preference was determined on the basis of 5 million Japanese yen per QALY societal willingness-to-pay threshold.

Results: The ICERs of the comprehensive treatment strategy over the medication-only strategy were 201,482 and 3,399 JPY per QALY for men and women, respectively. The resultant ICER was less than the 5 million JPY societal willingness-to-pay threshold. Deterministic sensitivity analysis and probabilistic sensitivity analysis revealed that the results varied with the input values, but the comprehensive strategy was likely to be more cost-effective than the medication-only strategy.

Conclusion: This cost-effectiveness study revealed that a comprehensive treatment strategy including sAVS and RFA was favorable compared with the medication-only strategy for managing stage I-III hypertension in 50-year-old men and women, with acceptable willingness-to-pay thresholds. This cost-effectiveness study revealed that a comprehensive treatment strategy for primary aldosteronism that included segmental adrenal sampling and radiofrequency ablation was favorable compared with the medication-only strategy for managing stage I-III hypertension in 50-year-old men and women, with acceptable willingness-to-pay thresholds.

Keywords: Adrenal venous sampling; Cost-effectiveness analysis; Primary aldosteronism; Radiofrequency ablation.

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Conflict of interest statement

Declarations. Conflict of interest: Kei Takase and Hideki Ota were supported by a research grant from Canon Medical Systems. The other authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Markov decision tree model for the hypertension management of patients suspected of having primary aldosteronism. M Markov decision section, PA primary aldosteronism, APA aldosterone-producing adenoma, BHA bilateral hyperaldosteronism, RFA radiofrequency ablation, CT computed tomography, AVS adrenal venous sampling, EHT essential hypertension
Fig. 2
Fig. 2
Tornado diagram of the incremental cost‒effectiveness ratios of the comprehensive strategy and the medication-only strategy in 50-year-old men with hypertension. The tornado diagram was constructed on the basis of the estimated ranges of each individual model-input parameter. The upper parameters have a greater effect on the incremental cost-effectiveness ratio. ICER incremental cost-effectiveness ratio, APA aldosterone-producing adenoma, PA primary aldosteronism, AVS adrenal venous sampling, RFA radiofrequency ablation
Fig. 3
Fig. 3
Sensitivity analysis for expected life-years. ICER incremental cost-effectiveness ratio, JPY Japanese yen
Fig. 4
Fig. 4
Probabilistic sensitivity analysis for the cost-effectiveness of the comprehensive strategy and medication-only strategy. The dots denote the results of the Monte Carlo simulations of 10,000 samples. More than 80% of the dots are located below the benchmark line for willingness-to-pay (5 million JPY per QALY); that is, the comprehensive strategy is cost-effective compared with the medication-only strategy
Fig. 5
Fig. 5
Cost-effectiveness analysis for sAVS and cAVS with/without RFA in 50-year-old men with hypertension. sAVS segmental adrenal venous sampling, RFA radiofrequency ablation, cAVS conventional adrenal venous sampling
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