https://orcid.org/0000-0001-9681-3388
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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.
Transparency
Declaration of funding
This work was funded by Vifor Pharma Group.
Declaration of financial/other relationships
MV and ARA are employed by Vifor Pharma Spain and Switzerland, respectively. DN and EP are employed by PharmaLex Spain and received financial support from Vifor Pharma Spain for the development of this study. JGJ, AGF and PS received an honorarium from the sponsor and participated as independent consultants.
Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Author contributions
MV, ARA, DN and EP contributed to the concept and design of the study, and to the analysis and interpretation of the data. All authors contributed to the critical revision of the manuscript for important intellectual content and read and approved the final version. All authors sufficiently contributed to this research according to ICMJE criteria to qualify as listed authors.
Acknowledgements
No assistance in the preparation of this article is declared by the authors.