OBJECTIVES: Hyperkalaemia (HK) is defined as and is associated with adverse clinical outcomes, including major adverse cardiovascular events (MACE), hospitalisation and mortality. Patients with chronic kidney disease (CKD) and heart failure (HF) are particularly susceptible to HK impaired renal function, older age, comorbidities, and concomitant medications. Patiromer, normalises K+ levels and enables continuation of treatment with renin-angiotensin-aldosterone system inhibitors (RAASis), which are used to manage CKD and HF. The objective of this study was to evaluate the cost-effectiveness of patiromer compared with standard of care for the treatment of HK in patients with CKD and HF from the NHS and PSS perspective in the UK.

METHODS: A lifetime, fixed-time increment, Markov model was developed. Disease progression was modelled according to health state transition probabilities through CKD stages until end-stage renal disease and in HF through NYHA classes. MACE, hospitalisation and mortality events, stratified by disease status, were informed by published event rates, with potassium levels and RAASi use impacting their incidence. Trial data and published event rates were utilised to predict HK incidence and RAASi discontinuation/down-titration. Direct healthcare costs (2020 GBP) and utility values were sourced from the published literature and discounted at 3.5%.

RESULTS: Treatment with patiromer was estimated to increase discounted life years and quality adjusted life years (QALYs) from 6.88 to 6.94 (+0.06) and 5.13 to 5.19 (+0.06), respectively. Incremental discounted costs were estimated at £971 per patient, with a resultant incremental cost-effectiveness ratio of £16,667 per QALY gained. Results were sensitive to the discount rate for benefits, the patiromer costs and RAASi impact on CKD progression.

CONCLUSIONS: With an ICER below the £20,000 per QALY gained threshold, patiromer is a cost-effective treatment for HK in patients with CKD and HF compared to standard of care in a UK setting, likely through the maintenance of RAASi use.