Saturday, June 15, 2024

Patiromer Proven Cost-Effective in Managing Hyperkalemia for Chronic Kidney Disease Patients in Italy

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Chronic kidney disease (CKD) patients frequently encounter hyperkalemia (HK), a condition exacerbated by comorbidities and the use of renin-angiotensin-aldosterone system inhibitors (RAASi). Standard care often requires down-titration or discontinuation of RAASi, which negatively impacts cardiorenal outcomes, increases hospitalizations, and elevates mortality risks. This study examines the cost-effectiveness of patiromer, a novel treatment for HK, in CKD patients with and without heart failure (HF) within the Italian healthcare framework.

Methods

Researchers developed a lifetime Markov cohort model grounded in the OPAL-HK study to evaluate the economic and health impacts of patiromer therapy compared to the standard of care (SoC). The model considered effects of HK and RAASi on clinical events, with outcomes including cumulative clinical events, number needed to treat (NNT), and incremental cost-effectiveness ratio (ICER). Subgroup analyses were performed on CKD patients with and without HF.

Results

The findings indicated that patiromer incurred an incremental discounted cost of €4,660 and provided 0.194 quality-adjusted life years (QALYs), resulting in an ICER of €24,004. Per 1000 patients, patiromer treatment prevented 275 moderate/severe HK events, 54 major adverse cardiovascular events, 246 RAASi discontinuations, and 213 RAASi up-titrations/restarts. Subgroup analysis revealed that patiromer was particularly effective in reducing clinical events in CKD patients with HF, although QALY gains were higher in those without HF (0.267 vs. 0.092).

Concrete Inferences

  • Patiromer treatment significantly reduces the occurrence of moderate to severe hyperkalemia events.
  • It aids in maintaining RAASi therapy, crucial for better cardiorenal outcomes.
  • Patiromer decreases the incidence of major adverse cardiovascular events among CKD patients.
  • Economic analysis supports patiromer’s cost-effectiveness, with an ICER of €24,004.
  • Quality of life improvements are more pronounced in CKD patients without HF.

Conclusively, patiromer offers significant quality-adjusted life year gains for CKD patients, both with and without HF, when juxtaposed with standard care in Italy. Its ability to prevent HK events, sustain RAASi therapy, and lower cardiovascular event risks underscores its value in clinical practice.

Original Article: Cost Eff Resour Alloc. 2024 May 21;22(1):42. doi: 10.1186/s12962-024-00547-y.

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