Cost-effectiveness of new guideline-based management for primary aldosteronism

Introduction The 2025 Endocrine Society Guideline expands PA screening to all patients with hypertension, even on interfering medication, and recommends repeat testing when appropriate, while adopting a more stratified approach to subsequent diagnostic evaluation. Materials and Methods In this simulation, we evaluated two guideline-directed screening and management strategies for PA in a cohort of patients with newly diagnosed hypertension. By developing a decision tree-Markov model and incorporating relevant parameters from epidemiological surveys and literature, we analyzed the cost-effectiveness with Quality-Adjusted Life Years (QALYs) and the incremental cost-effectiveness ratio (ICER). The model's reliability was evaluated through the sensitivity analysis. Results Within the Chinese healthcare setting, the updated guideline dominated the original strategy (cost: 3329.77USD vs. 3568.29USD; QALYs: 10.85 vs. 10.82), yielding an ICER of −7950.67USD/QALY. Across multiple scenario analyses, including alternative healthcare-cost settings and higher MRA treatment costs, the updated Guideline remained economically favorable. Sensitivity analyses and model validation further supported the overall stability and plausibility of the findings. Conclusions Over a 30-year horizon, management of PA under the updated Guideline is more cost-effective than the original Guideline.