Cost-effectiveness Analysis of Computed Tomography and Adrenal Scintigraphy in Primary Aldosteronism
Date Issued
2011
Date
2011
Author(s)
Lu, Ching-Chu
Abstract
Background：Primary aldosteronism is the most common cause of secondary hypertension. The two main causes of primary aldosteronism are aldosterone-producing adenoma, which could be cured by surgical intervention, and bilateral adrenal hyperplasia, which should be medical-treated. Computed tomography, adrenal venous sampling and adrenal scintigraphy are usually used for the etiology and lateralization of primary aldosteronism. Computed tomography is based on the anatomical findings, but it has wide variation of sensitivity. Adenal venous sampling is the gold standard for latearalization, but it is invasive and highly technical-dependent. Adrenal scintigraphy has limited role in primary aldosteronism during early days due to resolution. With the SPECT and SPECT/CT fusion imaging techique, the accuracy of adrenal scintigraphy is significant improved. The clinical algorithm for these modalities has not been well-established, and there are no studies concerning about the cost-effectiveness.
Objective：This study aimed on the comparison of the accuracy, average cost and cost-effectiveness analysis of four imaging modalities for differentiating the etiology of primary aldosteronism, including CT, NP-59 planar, NP-59 SPECT and NP-59 SPECT/CT.
Methods：We retrospectively included 27 clinical-confirmed primary aldosteronism patients from TAIPAI database. All of them had CT, NP-59 adrenal scintigraphy (plaran, SPECT and SPECT/CT) studies and pathology reports of adrenal lesion. The accuracy and average cost of these four imaging modalities were analyzed. By decision tress and setting effectiveness as diagnostic accuracy and diagnostic utility, cost-effectiveness were also analyzed. Sensitivity analysis were performed to determine the impact on the average cost while the variables changed.
Results：NP-59 SPECT/CT is the most accurate study among four imaging modalities, with borderline significance as compared with NP-59 planar and CT. NP-59 SPECT/CT bares the lowest average cost, and NP-59 planar bares the highest average cost. By setting diagnostic accuracy as the effectiveness, NP-59 SPECT/CT has the lowest cost-effectiveness ratio. If setting diagnostic utility as the effectiveness, NP-59 planar is considered a ineffectiveness study. In sensitivity analysis, if the sensitivity of NP-59 SPECT/CT decreases to 0%, the average cost of NP-59 SPECT/CT is still lower the average cost of CT. The average cost of NP-59 SPECT/CT is higher than the average cost of CT while the specificity of NP-59 SPECT/CT decreases to 59.5%.
Conclusion：Our study suggests that NP-59 SPECT/CT is the most accurate, the lowest average cost and the most cost-effective study among these four imaging modalities in differentiating the etiology of primary aldosteronism. It shows no significant impact on cost-effectiveness ratio as compared with CT while the sensitivity and specificity of NP-59 SPECT/CT changes. Aside from clinical concern, this result provides physicians consider the decision in another way to provide more effective management in primary aldosteronism.
Subjects
Primary aldosteronism
Computed tomography
adrenal scintigraphy
Decision tree
Cost-effectiveness analysis
Type
thesis
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