Oral Presentation ESA-SRB-NZSE-CaSR 2026 in conjunction with ENSA

Balancing the Pursuit of Cure and Testing Burden in Primary Aldosteronism: A Patient Preference Study (#3)

Yafei Si 1 , Grant Russell 2 , Mark Nelson 3 , Nigel Stocks 4 , Linghan Jia 5 , Stella Gwini 5 , Ben Favelle 6 , Judy Finn 6 , Sue Wong 6 , Jun Yang 5 , Gang Chen 1
  1. The University of Melbourne, Southbank, VIC, Australia
  2. Department of General Practice, Monash University, Melbourne, VIC, Australia
  3. Discipline of General Practice, University of Tasmania, Hobart, TAS, Australia
  4. Discipline of General Practice, Adelaide University, Adelaide, SA, Australia
  5. Centre for Endocrinology and Reproductive Health, Hudson Institute of Medical Research, Melbourne, VIC, Australia
  6. Primary Aldosteronism Centre of Research Excellence (PACE), Monash University, Melbourne, VIC, Australia

Background:

The 2025 Endocrine Society guideline recommends screening all adults with hypertension for primary aldosteronism (PA), with further investigations guided by whether patients would consider surgical treatment. However, little is known about what drives patient decisions to pursue additional testing rather than choosing long-term medical therapy.

 

Methods:

A nationwide discrete choice experiment was conducted among Australian adults with hypertension (January-February 2026). Participants, recruited by a first-party online panel provider, completed hypothetical choice tasks evaluating different PA testing pathways. Testing pathway scenarios varied according to clinical benefit (i.e. likelihood of identifying surgically curable PA and diagnostic accuracy) and practical considerations (i.e. waiting time, travel distance and out-of-pocket cost). Participants first chose between two testing options, then decided whether they preferred further testing or immediate medical therapy. Preferences were analysed using conditional logit models.

 

Results:

Among 497 participants (mean age 62.3±14.0 years; 52.7% female), lower cost, shorter waiting times, closer testing locations and higher diagnostic accuracy with higher likelihood of surgically curable disease were favoured, with avoidance of high out-of-pocket cost (AU$1,000 vs free testing) having the greatest influence. However, when choosing between further testing and immediate medical treatment, participants were more likely to choose testing when the likelihood of surgically curable PA was higher (70% vs 10% as the baseline) and diagnostic accuracy was greater (90% vs 50%), whereas waiting time, distance and cost had minimal influence. Reducing practical barriers alone increased predicted uptake of testing from 40.4% to 49.7%, while improving perceived clinical value increased uptake to 67.8%.

 

Conclusion:

Patients with hypertension value extended PA testing when the potential benefits, particularly the opportunity for cure and confidence in diagnosis, are clear. As PA management increasingly incorporates shared decision-making, improving access alone may be insufficient; patient-centred pathways must ensure diagnostic testing is not only easier to complete, but clearly worthwhile.