The Cost Effectiveness of Patiromer for the Treatment of Hyperkalaemia in Patients with Chronic Kidney Disease with and without Heart Failure in Ireland

Abstract

Background and ObjectiveHyperkalaemia can be a life-threatening condition, particularly in patients with advanced chronic kidney disease with and without heart failure. Renin-angiotensin-aldosterone system inhibitor therapy offers cardiorenal protection in chronic kidney disease and heart failure; however, it may also cause hyperkalaemia subsequently resulting in down-titration or discontinuation of treatment. Hence, there is an unmet need for hyperkalaemia treatment in patients with chronic kidney disease with and without heart failure to enable renin-angiotensin-aldosterone system inhibitor use in this patient population. In this study, we develop a de novo disease progression and cost-effectiveness model to evaluate the clinical and economic outcomes associated with the use of patiromer for the treatment of hyperkalaemia in patients with chronic kidney disease with and without heart failure. Methods A Markov model was developed using data from the OPAL-HK trial to assess the health economic impact of patiromer therapy in comparison to standard of care in controlling hyperkalaemia in patients with advanced chronic kidney disease with and without heart failure in the Irish setting. The model was designed to predict the natural history of chronic kidney disease and heart failure and quantify the costs and benefits associated with the use of patiromer for hyperkalaemia management over a lifetime horizon from a payer perspective. Results Treatment with patiromer was associated with an increase in discounted life-years (8.62 vs 8.37) and an increase in discounted quality-adjusted life-years (6.15 vs 5.95). Incremental discounted costs were predicted at €4979 per patient, with an incremental cost-effectiveness ratio of €25,719 per quality-adjusted life-year gained. Patients remained taking patiromer treatment for an average of 7.7 months, with treatment associated with reductions in the overall clinical event incidence and a delay in chronic kidney disease progression. Furthermore, patiromer was associated with lower overall rates of hospitalisation, major adverse cardiovascular events, dialysis, renin-angiotensin-aldosterone system inhibitor discontinuation episodes and renin-angiotensin-aldosterone system inhibitor down-titration episodes. At a willingness-to-pay threshold of €45,000 per quality-adjusted life-year in Ireland, treatment with patiromer was estimated to have a 100% chance of cost effectiveness compared with standard of care. Conclusions This study has demonstrated an economic case for the reimbursement of patiromer for the treatment of hyperkalaemia in patients with chronic kidney disease with and without heart failure in Ireland. Patiromer was estimated to improve life expectancy and quality-adjusted life expectancy, whilst incurring marginal additional costs when compared with current standard of care. Results are predominantly attributed to the ability of patiromer to enable the continuation of renin-angiotensin-aldosterone system inhibitor treatment whilst also reducing potassium levels.

Hyperkalemia in chronic kidney disease patients with and without heart failure: an Italian economic modelling study

“…A previously published lifetime Markov cohort model was adapted to assess the economic impact of patiromer therapy in comparison to standard of care (SoC), in controlling HK in CKD patients with and without HF, from a payer’s perspective [ 18 ]. The model was designed to predict the natural history of CKD and HF and quantify the direct medical costs and benefits associated with patiromer use for serum potassium management in patients in Italy.…”

A cost-effectiveness analysis of patiromer in the UK: evaluation of hyperkalaemia treatment and lifelong RAASi maintenance in chronic kidney disease patients with and without heart failure

“…The modelling approach has previously been published [33] and was developed in order to extrapolate results from the OPAL-HK trial. This trial was used to assess the efficacy and safety of patiromer and was an international, multicentre, single blind, phase III clinical trial investigating the acute treatment of HK, and the ongoing maintenance of normokalaemia.…”

“…The model evaluates patiromer use against current SoC, as previously published. [33] It should be noted that modelling SoC is particularly challenging, due to the considerable heterogeneity associated with HK pathogenesis, methods to correct and manage potassium levels (particularly nonpharmacological interventions, and variable levels of adherence to pharmacological methods), and patient responses to such interventions. As such, SoC has been defined consistently with the broad definitions used in the OPAL-HK study, where SoC can be considered acute management for the correction of potassium and lifestyle interventions for the background maintenance of potassium (e.g., dietary intervention and modification of concomitant medications).…”

“…The model was used to evaluate the lifetime impact of patiromer use against SoC for the treatment of HK in patients with CKD with and without HF, as previously published. [33] Modelled outcomes focused on health care costs, life years and quality-adjusted life years (QALYs), with comparisons between treatments made using the incremental cost-effectiveness ratio (ICER).…”

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

“…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.…”