Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia.
Department of Medicine, Hospital Canselor Tuanku Muhriz, Kuala Lumpur 56000, Malaysia.
J Clin Endocrinol Metab. 2024 Jun 17;109(7):1718-1725. doi: 10.1210/clinem/dgae039.
While guidelines have been formulated for the management of primary aldosteronism (PA), following these recommendations may be challenging in developing countries with limited health care access.
We aimed to assess the availability and affordability of health care resources for managing PA in the Association of Southeast Asian Nations (ASEAN) region, which includes low-middle-income countries.
We instituted a questionnaire-based survey to specialists managing PA, assessing the availability and affordability of investigations and treatment. Population and income status data were taken from the national census and registries.
Nine ASEAN country members (48 respondents) participated. While screening with aldosterone-renin ratio is performed in all countries, confirmatory testing is routinely performed in only 6 countries due to lack of facilities and local assays, and cost constraint. Assays are locally available in only 4 countries, and some centers have a test turnaround time exceeding 3 weeks. In 7 countries (combined population of 442 million), adrenal vein sampling (AVS) is not routinely performed due to insufficient radiological facilities or trained personnel, and cost constraint. Most patients have access to adrenalectomy and medications. In 6 countries, the cost of AVS and adrenalectomy combined is more than 30% of its annual gross domestic product per capita. While most patients had access to spironolactone, it was not universally affordable.
Large populations currently do not have access to the health care resources required for the optimal management of PA. Greater efforts are required to improve health care access and affordability. Future guideline revisions for PA may need to consider these limitations.
虽然已经制定了原发性醛固酮增多症（PA）的管理指南，但在医疗保健资源有限的发展中国家，遵循这些建议可能具有挑战性。
我们旨在评估东南亚国家联盟（ASEAN）地区（包括中低收入国家）管理 PA 的医疗保健资源的可及性和负担能力。
我们采用问卷调查的方式对管理 PA 的专家进行评估，评估调查和治疗的可及性和负担能力。人口和收入状况数据取自全国人口普查和登记册。
有 9 个 ASEAN 成员国（48 名受访者）参与了调查。虽然所有国家都在进行醛固酮-肾素比值筛查，但由于缺乏设施和当地检测方法以及费用限制，仅在 6 个国家常规进行确认性检测。只有 4 个国家可以进行本地检测，一些中心的检测周转时间超过 3 周。在 7 个国家（总人口为 4.42 亿），由于缺乏放射学设施或训练有素的人员以及费用限制，常规不进行肾上腺静脉采样（AVS）。大多数患者可以接受肾上腺切除术和药物治疗。在 6 个国家，AVS 和肾上腺切除术的费用合计超过其人均国民生产总值的 30%。尽管大多数患者都可以使用螺内酯，但并非普遍负担得起。
目前，大量人群无法获得优化 PA 管理所需的医疗保健资源。需要加大力度改善医疗保健的可及性和负担能力。未来的 PA 指南修订可能需要考虑到这些限制。
