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Ramirez de Arellano A, Jakutis G, Hunt B. Cost analysis of patiromer vs sodium zirconium cyclosilicate for the treatment of hyperkalemia in Spain and the UK. J Med Econ 2024; 27:1011-1017. [PMID: 39023516 DOI: 10.1080/13696998.2024.2382033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Hyperkalemia is an electrolyte abnormality with potentially life-threatening consequences. Published data have shown that potassium-binding polymer patiromer (Veltassa) is associated with reduced rates of severe edema and hospitalization for heart failure compared with sodium zirconium cyclosilicate (SZC, Lokelma) when treating hyperkalemia. The aim of this study was to evaluate the possible costs associated with these interventions in the Spanish and UK settings. METHODS A cost-analysis model was developed in Microsoft Excel to compare the costs associated with patiromer and SZC for the management of hyperkalemia. Clinical event rates were taken from a published real-world comparative study, with the base case capturing the statistically significant reduction in severe edema with patiromer vs SZC and a sensitivity analysis also including the non-statistically significant reduction in hospitalization for heart failure. Country-specific costs, expressed in 2022 Euros (EUR) and British pounds sterling (GBP), were evaluated from a healthcare payer perspective and included pharmacy costs and costs of clinical events. RESULTS Patiromer may be associated with cost savings of EUR 107 and GBP 630 per patient-year of treatment vs SZC in Spain and the UK, respectively. The majority of cost savings were due to the possible lower daily cost of patiromer compared with SZC. Including the difference in heart failure hospitalization rates in a sensitivity analysis led to greater cost savings with patiromer over SZC, increasing to EUR 460 and GBP 902 in Spain and the UK, respectively. Extrapolation of patient-level economic outcomes to a population level found that patiromer was associated with annual cost savings of EUR 30.6 million in Spain, and GBP 801.7 million in the UK vs SZC. CONCLUSIONS Patiromer has the potential to be cost saving vs SZC for the treatment of hyperkalemia in Spain and the UK based on the results of a real-world evidence analysis.
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Affiliation(s)
| | | | - Barnaby Hunt
- Ossian Health Economics and Communications, Basel, Switzerland
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Delgado-Jiménez JF, Segovia-Cubero J, Almenar-Bonet L, de Juan-Bagudá J, Lara-Padrón A, García-Pinilla JM, Bonilla-Palomas JL, López-Fernández S, Mirabet-Pérez S, Gómez-Otero I, Castro-Fernández A, Díaz-Molina B, Goirigolzarri-Artaza J, Rincón-Díaz LM, Pascual-Figal DA, Anguita-Sánchez M, Muñiz J, Crespo-Leiro MG. Prevalence, Incidence, and Outcomes of Hyperkalaemia in Patients with Chronic Heart Failure and Reduced Ejection Fraction from a Spanish Multicentre Study: SPANIK-HF Design and Baseline Characteristics. J Clin Med 2022; 11:jcm11051170. [PMID: 35268260 PMCID: PMC8910891 DOI: 10.3390/jcm11051170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/01/2023] Open
Abstract
Hyperkalaemia is a growing concern in the treatment of patients with heart failure and reduced ejection fraction (HFrEF) as it limits the use of some prognostic-modifying drugs and has a negative impact on prognosis. The objective of the present study was to estimate the prevalence of hyperkalaemia in outpatients with HFrEF and its impact on achieving optimal medical treatment. For this purpose, a multicentre, prospective, and observational study was carried out on consecutive HFrEF patients who were monitored as outpatients in heart failure (HF) units and who, in the opinion of their doctor, received optimal medical treatment. A total of 565 HFrEF patients were included from 16 specialised HF units. The mean age was 66 ± 12 years, 78% were male, 45% had an ischemic cause, 39% had atrial fibrillation, 43% were diabetic, 42% had a glomerular filtration rate < 60 mL/min/1.7 m2, and the mean left ventricular ejection fraction was 31 ± 7%. Treatment at the study entry included: 76% on diuretics, 13% on ivabradine, 7% on digoxin, 18.9% on angiotensin-conversing enzyme inhibitors (ACEi), 11.3% on angiotensin receptors blockers (ARBs), 63.8% on angiotensin-neprilysin inhibitors (ARNi), 78.5% on mineralocorticoid receptor antagonists (MRAs), and 92.9% on beta-blockers. Potassium levels in the baseline analysis were: ≤5 mEq/L = 80.5%, 5.1−5.4 mEq/L = 13.8%, 5.5−5.9 mEq/L = 4.6%, and ≥6 mEq/L = 1.06%. Hyperkalaemia was the reason for not prescribing or reaching the target dose of an MRAs in 34.8% and 12.5% of patients, respectively. The impact of hyperkalaemia on not prescribing or dropping below the target dose in relation to ACEi, ARBs, and ARNi was significantly less. In conclusion, hyperkalaemia is a frequent problem in the management of patients with HFrEF and a limiting factor in the optimisation of medical treatment.
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Affiliation(s)
- Juan F. Delgado-Jiménez
- Instituto de Investigación y Servicio de Cardiología del Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Correspondence:
| | - Javier Segovia-Cubero
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, 28222 Madrid, Spain
| | - Luis Almenar-Bonet
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Hospital Universitario La Fe, 46026 Valencia, Spain
| | - Javier de Juan-Bagudá
- Instituto de Investigación y Servicio de Cardiología del Hospital Universitario 12 de Octubre, 28041 Madrid, Spain;
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
| | - Antonio Lara-Padrón
- Servicio de Cardiología, Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Spain;
| | - José Manuel García-Pinilla
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, International Business Information Management Association, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
| | | | - Silvia López-Fernández
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
| | - Sonia Mirabet-Pérez
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Inés Gómez-Otero
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Complexo Hospitalario Universitario de Santiago de Compostela, 15706 A Coruña, Spain
| | | | - Beatriz Díaz-Molina
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Josebe Goirigolzarri-Artaza
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Hospital Universitario Clínico de San Carlos, 28040 Madrid, Spain
| | - Luis Miguel Rincón-Díaz
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Domingo Andrés Pascual-Figal
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain
| | | | - Javier Muñiz
- Instituto de Investigación Biomédica de A Coruña, Universidade da Coruña (UDC), 15006 A Coruña, Spain;
| | - María G. Crespo-Leiro
- Centro de Investigación Biomédica En Red Cardiovascular (CIBERCV), 28029 Madrid, Spain; (J.S.-C.); (L.A.-B.); (J.M.G.-P.); (S.M.-P.); (I.G.-O.); (B.D.-M.); (J.G.-A.); (L.M.R.-D.); (D.A.P.-F.); (M.G.C.-L.)
- Servicio de Cardiología, Complexo Hospitalario Universitario, 15006 A Coruña, Spain
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González-Juanatey JR, González-Franco Á, de Sequera P, Valls M, Ramirez de Arellano A, Pomares E, Nieves D. A cost-effectiveness analysis of patiromer for the treatment of hyperkalemia in chronic kidney disease patients with and without heart failure in Spain. J Med Econ 2022; 25:640-649. [PMID: 35510569 DOI: 10.1080/13696998.2022.2074193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS Renin-angiotensin-aldosterone system inhibitors (RAASi) therapy is commonly used to reduce the risk of death and to slow down disease progression in patients with chronic kidney disease (CKD), heart failure (HF) and hypertension. However, the cardio-renal benefits of RAASi therapy are also associated with an increased risk of hyperkalemia (HK), which may lead to dose reduction or discontinuation of therapy. Patiromer has demonstrated to reduce the risk of HK, which enables to maintain optimal doses of RAASi therapy. This study aimed to assess the cost-effectiveness of patiromer for the management of HK in CKD patients with and without HF in Spain. METHODS A Markov model was developed to evaluate the costs and benefits of patiromer for the management of HK in patients with CKD stages 3-4 with and without HF treated with RAASi over a lifetime horizon. The main outcomes included total direct costs (€2021), quality-adjusted life-years (QALYs), life-years gained (LYG) and incremental cost-effectiveness ratio (ICER). Deterministic one-way and probabilistic sensitivity analyses were performed to assess the robustness of the results. RESULTS Patiromer was more effective compared to no patiromer (5.76 vs 5.57 QALYs; 7.73 vs 7.50 LYG), and resulted in an incremental cost of €3,574, yielding an ICER of €19,092/QALY gained and of €15,236/LYG. Sensitivity analyses suggested that the results were robust to changes in most input parameters. CONCLUSIONS Patiromer is a cost-effective intervention in maintaining normokalemia and enabling optimal RAASi therapy in patients with CKD stages 3-4 with and without HF in Spain.
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Affiliation(s)
| | - Álvaro González-Franco
- Servicio Medicina Interna, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Patricia de Sequera
- Servicio Nefrología, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid, Spain
| | - Marta Valls
- Market Access, Vifor Pharma Group., Barcelona, Spain
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Olry de Labry Lima A, Díaz Castro Ó, Romero-Requena JM, García Díaz-Guerra MDLR, Arroyo Pineda V, de la Hija Díaz MB, Ascanio M, Darbà J, Cruzado JM. Hyperkalaemia management and related costs in chronic kidney disease patients with comorbidities in Spain. Clin Kidney J 2021; 14:2391-2400. [PMID: 34754435 PMCID: PMC8573009 DOI: 10.1093/ckj/sfab076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hyperkalaemia (HK) is a common electrolyte disorder in patients with chronic kidney disease (CKD) and/or treated with renin-angiotensin-aldosterone system inhibitors (RAASis). The aim of this study is to determine the severity, current management and cost of chronic HK. METHODS We performed a retrospective cohort study of patients with chronic HK and CKD, heart failure or diabetes mellitus between 2011 and 2018. The study follow-up was 36 months. RESULTS A total of 1499 patients with chronic HK were analysed: 66.2% presented with mild HK, 23.4% with moderate HK and 10.4% with severe HK. The severity was associated with CKD stage. Most patients (70.4%) were on RAASi therapies, which were frequently discontinued (discontinuation rate was 39.8, 49.8 and 51.8% in mild, moderate and severe HK, respectively). This RAASi discontinuation was similar with or without resin prescription. Overall, ion-exchange resins were prescribed to 42.5% of patients with HK and prescriptions were related to the severity of HK, being 90% for severe HK. Adherence to resin treatment was very low (36.8% in the first year and 17.5% in the third year) and potassium remained elevated in most patients with severe HK. The annual healthcare cost per patient with HK was €5929, reaching €12 705 in severe HK. Costs related to HK represent 31.9% of the annual cost per HK patient and 58.8% of the specialized care cost. CONCLUSIONS HK was usually managed by RAASi discontinuation and ion-exchange resin treatment. Most patients with HK were non-adherent to resins and those with severe HK remained with high potassium levels, despite bearing elevated healthcare expenditures.
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Affiliation(s)
- Antonio Olry de Labry Lima
- Escuela Andaluza de Salud Pública, Granada, Spain
- CIBER en Epidemiología y Salud Pública, Madrid, Spain
- Instituto de Investigación Biosanitaria, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Óscar Díaz Castro
- Servizo de Cardioloxía, Complejo Hospitalario Universitario de Vigo, Servizo Galego de Saúde, Vigo, Pontevedra, Spain
| | | | | | - Virginia Arroyo Pineda
- Servicio de Farmacia de Atención Primaria, Hospital Nuestra Señora del Prado, Talavera de la Reina (Toledo), Spain
| | - M Belén de la Hija Díaz
- Servicio de Farmacia de Atención Primaria, Hospital Nuestra Señora del Prado, Talavera de la Reina (Toledo), Spain
| | | | - Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
| | - Josep M Cruzado
- Department of Nephrology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
- Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain
- Spanish Network for Renal Research, ISCIII, Madrid, Spain
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