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Cost Analysis of Radiofrequency Ablation for Adrenal Adenoma in Patients with Primary Aldosteronism and Hypertension: Results from the ADERADHTA Pilot Study and Comparison with Surgical Adrenalectomy

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Abstract

Purpose

Primary Aldosteronism (PA) is increasingly considered as a common disease affecting up to 10% of the hypertensive population. Standard of care comprises laparoscopic total adrenalectomy but innovative treatment such as RadioFrequency Ablation (RFA) constitutes an emerging promising alternative to surgery. The main aim of this study is to analyse the cost of RFA versus surgery on aldosterone-producing adenoma patient from the French National Health Insurance (FNHI) perspective.

Methods

The ADERADHTA study was a prospective pilot study aiming to evaluate both safety and efficacy of the novel use of adrenal RFA on the patients with PA. This study conducted on two French sites and enrolled adult patients, between 2016 and 2018, presenting hypertension and underwent the RFA procedure. Direct medical (inpatient and outpatient) and non-medical (transportation, daily allowance) costs were calculated over a 6-month follow-up period. Moreover, the procedure costs for the RFA were calculated from the hospital perspective. Descriptive statistics were implemented.

Results

Analysis was done on 21 patients in RFA groups and 27 patients in the surgery group.

The difference in hospital costs between the RFA and surgery groups was €3774 (RFA: €1923; Surgery: €5697 p < 0.001) in favour of RFA. Inpatient and outpatient costs over the 6-month follow-up period were estimated at €3,48 for patients who underwent RFA. The production cost of implementing the RFA procedure was estimated at €1539 from the hospital perspective.

Conclusion

Our study was the first to show that RFA is 2 to 3 times less costly than surgery.

The trial is registered at ClinicalTrials.gov under the number NCT02756754.

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Acknowledgments

The authors are grateful to the sponsoring team (ME Llau, A Pauze and L Chabbert) and clinical research assistants (M Rodriguez, Toulouse; J Gaudissard, Bordeaux) for their contributions. Sources of funding: The Societé Française d’HyperTension Artérielle (SFHTA: French Society of Hypertension) provided funding for the study; this study was supported by a grant from the French Ministry of Health with the participation of the Groupement Interrégional de Recherche Clinique et d’Innovation Sud-Ouest Outre-Mer Hospitalier (PHRCI 2015).

Funding

This study was supported by a grant from the French Ministry of Health with the participation of the Groupement Interrégional de Recherche Clinique et d’Innovation Sud-Ouest Outre-Mer Hospitalier (PHRCI 2015). The funder plays no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.

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Correspondence to Nadège Costa or Michael Mounie.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

The study protocol was reviewed and approved by an ethics committee and the French Competent Authorities.

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Costa, N., Mounie, M., Gombault-Datzenko, E. et al. Cost Analysis of Radiofrequency Ablation for Adrenal Adenoma in Patients with Primary Aldosteronism and Hypertension: Results from the ADERADHTA Pilot Study and Comparison with Surgical Adrenalectomy. Cardiovasc Intervent Radiol 46, 89–97 (2023). https://doi.org/10.1007/s00270-022-03295-9

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