Cost‐Effectiveness of Therapeutic Drug Monitoring in Diagnosing Primary Aldosteronism in Patients With Resistant Hypertension

<jats:p>Primary aldosteronism (<jats:styled-content style="fixed-case">PA</jats:styled-content>) is present in up to 20% of patients with treatment‐resistant hypertension (<jats:styled-content style="fixed-case">TRH</jats:styled-content>). Investigation for <jats:styled-content style="fixed-case">PA</jats:styled-content> in patients with <jats:styled-content style="fixed-case">TRH</jats:styled-content> is recommended by current guidelines after medication nonadherence is excluded. Studies using therapeutic drug monitoring (<jats:styled-content style="fixed-case">TDM</jats:styled-content>) have shown that >50% of patients with <jats:styled-content style="fixed-case">TRH</jats:styled-content> are nonadherent to their prescribed antihypertensive medications. However, the relationship between the prevalence of <jats:styled-content style="fixed-case">PA</jats:styled-content> and medication adherence as confirmed by <jats:styled-content style="fixed-case">TDM</jats:styled-content> has not been previously assessed. A retrospective analysis from a hypertension referral clinic showed that prevalence of <jats:styled-content style="fixed-case">PA</jats:styled-content> in adherent patients with <jats:styled-content style="fixed-case">TRH</jats:styled-content> by <jats:styled-content style="fixed-case">TDM</jats:styled-content> was significantly higher than in nonadherent patients (28% vs 8%, <jats:italic>P</jats:italic><.05). Furthermore, cost analysis showed that <jats:styled-content style="fixed-case">TDM</jats:styled-content>‐guided <jats:styled-content style="fixed-case">PA</jats:styled-content> screening was $590.69 less expensive per patient, with minimal impact on the diagnostic accuracy. These data support a <jats:styled-content style="fixed-case">TDM</jats:styled-content>‐guided <jats:styled-content style="fixed-case">PA</jats:styled-content> screening approach as a cost‐saving strategy compared with routine <jats:styled-content style="fixed-case">PA</jats:styled-content> screening for <jats:styled-content style="fixed-case">TRH</jats:styled-content>.</jats:p>