Preferences for Subtyping Primary Aldosteronism: A Discrete Choice Experiment

Context: Primary aldosteronism (PA) affects 10% to 15% of individuals with hypertension and increases cardiovascular risk. Differentiating between unilateral and bilateral PA determines optimal treatment and typically requires adrenal vein sampling (AVS). Emerging subtyping methods include predictive algorithms and nuclear imaging. Objective: This study explores hypertensive individuals' preferences for different PA subtyping strategies. Methods: Two labeled discrete choice experiments (DCEs) evaluated preferences for subtyping methods based on test accuracy, waiting time, adverse effects, and out-of-pocket cost. Latent class conditional logit (LCL) modeling segmented participants by preferences, while policy simulation analyses examined uptake variations by age, sex, and income. Results: Among 583 hypertensive Australian adults (mean age: 48 years; 48% female), 85% were willing to undergo PA subtyping. Participants prioritized accuracy, shorter waiting times, minimal side effects, and lower costs. LCL analysis revealed that participants who were older, female, or considered themselves less busy were more likely to opt for PA subtyping. Subtyping uptake was highest for algorithm-based methods (∼54%) with its uptake rate increasing to 68% after factoring in cost. Conclusion: Preferences for PA subtyping are driven by cost, invasiveness, and waiting time. Less-invasive, faster, and low-cost methods were preferred, even if they are slightly less accurate than AVS. Further research is needed to optimize the accuracy of subtyping algorithms and facilitate implementation in clinical practice.