Fewer Pills, Lower Bills: Antihypertensive and Cost Outcomes of Adrenalectomy in Primary Aldosteronism

BACKGROUND: Primary aldosteronism (PA) can be treated surgically or medically depending on disease lateralization and surgical candidacy. There is a dearth of data directly comparing antihypertensive medication trajectories and costs between these strategies. PATIENTS AND METHODS: Data Mart Database (2004-2022). Patients were stratified by receipt of adrenalectomy versus medical management alone. The index time point was defined as adrenal vein sampling (AVS) for medically managed and adrenalectomy for surgically managed patients. Outcomes were assessed using regression models. RESULTS: Of 911 patients, 52% underwent adrenalectomy and 48% medical therapy. Adrenalectomy patients were younger, with higher Elixhauser scores. Antihypertensive medication use (2.9 versus 2.8, p = 0.636) and costs did not differ at index. After 1 year, adrenalectomy patients used fewer antihypertensive medications (1.5 ± 1.4) than medically managed patients (2.5±1.5, p < 0.001). On regression, age (β = 0.02, p = 0.002), male sex (β = 0.40, p < 0.001), and baseline antihypertensive medications (β = 0.43, p < 0.001) were associated with higher antihypertensive medication requirement. Adrenalectomy patients were prescribed 1.11 fewer antihypertensive medications at one year (p < 0.001). In the resistant hypertension subcohort, adrenalectomy reduced antihypertensive medications by 1.35 (p < 0.001). Adrenalectomy was associated with US $908 lower antihypertensive medication prescription costs (p < 0.001) and 87% lower odds of potassium supplementation (p < 0.001). CONCLUSIONS: Patients with PA who undergo adrenalectomy demonstrate a significant reduction in antihypertensive medications compared with medically managed patients. While there is significant upfront cost to surgical intervention, reduced long-term prescription costs are realized.