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 normalizes K+ levels and enables continuation of treatment with renin-angiotensin-aldosterone system inhibitors (RAASi), 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 perspective of the healthcare payer in Ireland.

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 New York Heart Association 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 (2019 Euro) and utility values were sourced from published literature and discounted at 4.0%.

RESULTS: Treatment with patiromer was estimated to increase discounted life years and quality adjusted life years (QALYs) from 6.72 to 6.78 (+0.06) and 5.02 to 5.07 (+0.05), respectively. Incremental discounted costs were estimated at €99 per patient, with a resultant incremental cost-effectiveness ratio of €1,734 per QALY gained. Results were most sensitive to the magnitude of the impact of RAASi use on mortality and CKD progression, alongside the rate of discontinuation of patiromer and its cost.

CONCLUSIONS: Patiromer is cost-effective for the treatment of HK in patients with CKD and HF compared with standard of care in Ireland, likely through the maintenance of RAASi use.