OBJECTIVES

Optimal renin-angiotensin-aldosterone system inhibitors (RAASi) therapy has demonstrated to delay progression of chronic kidney disease (CKD), heart failure (HF) and hypertension. However, RAASi therapy is associated with an increased risk of hyperkalaemia (HK), leading to dose reduction or discontinuation of therapy and shortening its potential cardio-renal benefits. Patiromer is a novel therapy for HK treatment that maintains normokalaemia and also enables to maintain RAASi therapy. This study aimed to assess the cost-effectiveness of patiromer versus no patiromer for the management of HK in patients with CKD with or without HF from the Spanish healthcare perspective.

METHODS

A Markov model was developed to predict the natural history of disease for patients with stage 3-4 CKD with or without HF treated with RAASi, and evaluate the costs and benefits associated with the use of patiromer for the management of HK in a lifetime horizon. Clinical data and utility values were obtained from the OPAL-HK trial and published literature, and costs were gathered from national databases. The main outcomes of the model included total direct costs (expressed in €, 2021), quality-adjusted life years (QALYs), life years gained (LYG) and incremental cost-effectiveness ratio (ICER). An annual discount rate of 3% was applied to costs and health outcomes. Deterministic and probabilistic sensitivity analysis were performed to assess the robustness of the results.

RESULTS

Lifetime treatment with patiromer was more effective than no patiromer (5.51 vs 5.43 QALYs; 7.33 vs 7.25 LYG), but resulted in an incremental cost of €541, yielding an ICER of €7,115/QALY gained and of €6,646/LYG. Sensitivity analyses suggested that the results were robust to changes in most input parameters.

CONCLUSIONS

Patiromer was projected to be a cost-effective intervention for the treatment of HK and maintenance of RAASi therapy in patients with stage 3-4 CKD with or without HF in Spain.