A Cost-Utility Analysis Of Raasi Enabling-Patiromer In Patients With Hyperkalemia

Sutherland, C. Simone; Braunhofer, PG; Vrouchou, P; Stiphout, Joris Van; Messerli, Markus; Suter, Katja; Zadok, N; Schwenkglenks, Matthias; Ademi, Zanfina

doi:10.1016/j.jval.2017.08.519

Cited by 5 publications

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“…In this regard, it has been demonstrated by mathematical models that hyperkalemia prevention and treatment with patiromer is a potentially cost-effective intervention for the long-term maintenance of RAASi in patients at risk of hyperkalemia [82].…”

Section: Discussionmentioning

confidence: 99%

New Treatment Options for Hyperkalemia in Patients with Chronic Kidney Disease

Esposito

Conti

Falqui

et al. 2020

JCM

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Hyperkalemia may cause life-threatening cardiac and neuromuscular alterations, and it is associated with high mortality rates. Its treatment includes a multifaceted approach, guided by potassium levels and clinical presentation. In general, treatment of hyperkalemia may be directed towards stabilizing cell membrane potential, promoting transcellular potassium shift and lowering total K+ body content. The latter can be obtained by dialysis, or by increasing potassium elimination by urine or the gastrointestinal tract. Until recently, the only therapeutic option for increasing fecal K+ excretion was represented by the cation-exchanging resin sodium polystyrene sulfonate. However, despite its common use, the efficacy of this drug has been poorly studied in controlled studies, and concerns about its safety have been reported. Interestingly, new drugs, namely patiromer and sodium zirconium cyclosilicate, have been developed to treat hyperkalemia by increasing gastrointestinal potassium elimination. These medications have proved their efficacy and safety in large clinical trials, involving subjects at high risk of hyperkalemia, such as patients with heart failure and chronic kidney disease. In this review, we discuss the mechanisms of action and the updated data of patiromer and sodium zirconium cyclosilicate, considering that the availability of these new treatment options offers the possibility of improving the management of both acute and chronic hyperkalemia.

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Section: Discussionmentioning

confidence: 99%

New Treatment Options for Hyperkalemia in Patients with Chronic Kidney Disease

Esposito

Conti

Falqui

et al. 2020

JCM

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“…13 Nonetheless, cost considerations of this new therapy, especially in the long-term for patients with chronic HK, may influence clinical practice and subsidy recommendations. While several cost-effectiveness studies on patiromer (another new potassium binder agent) demonstrated costeffectiveness when compared with established benchmarks from the United States and European healthcare system perspectives, [14][15][16][17] studies on SZC are relatively scarce. Only one recent study on SZC showed it to be cost-effective from the perspective of Scandinavian healthcare systems.…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of sodium zirconium cyclosilicate for advanced chronic kidney patients in Singapore

Chay,

Choo,

Finkelstein

2024

Nephrology

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IntroductionHyperkalaemia (HK) is prevalent among patients with chronic kidney disease (CKD) and chronic heart failure, especially if they are treated with renin‐angiotensin‐aldosterone system inhibitors (RAASi). This study evaluated the cost‐effectiveness of a newly developed anti‐HK therapy, sodium zirconium cyclosilicate (SZC), to the current standard of care for treating HK in advanced CKD patients from the Singapore health system perspective.MethodsWe adapted a global microsimulation model to simulate individual patients' potassium level trajectories with baseline potassium ≥5.5 mmol/L, CKD progression, changes in treatment, and other fatal and non‐fatal events. Effectiveness data was derived from ZS‐004 and ZS‐005 trials. Model parameters were localised using CKD patients' administrative and medical records at the Singapore General Hospital Department of Renal Medicine. We estimated the lifetime cost and quality‐adjusted life years (QALYs) of each HK treatment, and the incremental cost‐effectiveness ratio of SZC.ResultsSZC demonstrated cost‐effectiveness with an incremental cost‐effectiveness ratsio of SGD 45 068 per QALY over a lifetime horizon, below the willingness‐to‐pay threshold of SGD 90 000 per QALY. Notably, SZC proved most cost‐effective for patients with less severe CKD who were concurrently using RAASi. Sensitivity analyses confirmed the robustness of the findings, accounting for alternative parameter values and statistical uncertainty.ConclusionThis study establishes the cost‐effectiveness of SZC as a treatment for HK, highlighting its potential to mitigate the risk of hyperkalaemia and optimise RAASi therapy. These findings emphasise the value of integrating SZC into the Singapore health system for improved patient outcomes and resource allocation.

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“…Patiromer significantly lowers P-potassium in patients with CKD 31 32. Several studies have proposed the use of patiromer to allow for increased RAAS blockade in patients with hyperkalaemia, CKD and suboptimal RAAS blockade treatment 33. Hyperkalaemia may be addressed through dietary restrictions, but these have limited effect, a profound impact on patient’s lifestyle and freedom and limit the intake of healthy fresh fruits and vegetables 34…”

Section: Introductionmentioning

confidence: 99%

Can patiromer allow for intensified renin–angiotensin–aldosterone system blockade with losartan and spironolactone leading to decreased albuminuria in patients with chronic kidney disease, albuminuria and hyperkalaemia? An open-label randomised controlled trial: MorphCKD

et al. 2022

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IntroductionChronic kidney disease (CKD) is associated with significantly increased morbidity and mortality. No specific treatment of the underlying condition is available for the majority of patients, but ACE-inhibitors (ACE-I) and angiotensin II-receptor blockers (ARB) slows progression in albuminuric CKD. Adding a mineralocorticoid receptor-antagonist (MRA) like spironolactone has an additive effect. However, renin–angiotensin–aldosterone system (RAAS)-blockade increases the risk of hyperkalaemia which is exacerbated by the presence of CKD. Thus, hyperkalaemia may prevent optimal use of RAAS-blockade in some patients.This project hypothesises that adding a potassium binder (patiromer) allows for improved RAAS-blockade including the use of MRA, thereby reducing albuminuria in patients with albuminuric CKD where full treatment is limited by hyperkalaemia.If successful, the study may lead to improved treatment of this subgroup of patients with CKD. Furthermore, the study will examine the feasibility of potassium binders in patients with CKD.Methods and analysisAn open-label, randomised controlled trial including 140 patients with estimated glomerular filtration rate (eGFR) 25–60 mL/min/1.73 m2, a urinary albumin/creatinine ratio (UACR) >500 mg/g (or 200 mg/g if diabetes mellitus) and a current or two previous plasma-potassium >4.5 mmol/L. Patients who develop hyperkaliaemia >5.5 mmol/L during a run-in phase, in which RAAS-blockade is intesified with the possible addition of spironolactone, are randomised to 12-month treatment with maximal tolerated ACE-I/ARB and spironolactone with or without patiromer.The primary endpoint is the difference in UACR measured at randomisation and 12 months compared between the two groups. Secondary endpoints include CKD progression, episodes of hyperkalaemia, blood pressure, eGFR, markers of cardiovascular disease, diet and quality of life.Ethics and disseminationThis study is approved by The Central Denmark Region Committees on Health Research Ethics (REFNO 1-10-72-110-20) and is registered in the EudraCT database (REFNO 2020-001595-15). Results will be presented in peer-reviewed journals, at meetings and at international conferences.

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A Cost-Utility Analysis Of Raasi Enabling-Patiromer In Patients With Hyperkalemia

Cited by 5 publications

References 0 publications

New Treatment Options for Hyperkalemia in Patients with Chronic Kidney Disease

New Treatment Options for Hyperkalemia in Patients with Chronic Kidney Disease

Cost‐effectiveness of sodium zirconium cyclosilicate for advanced chronic kidney patients in Singapore

Can patiromer allow for intensified renin–angiotensin–aldosterone system blockade with losartan and spironolactone leading to decreased albuminuria in patients with chronic kidney disease, albuminuria and hyperkalaemia? An open-label randomised controlled trial: MorphCKD

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