OBJECTIVES:

Chronic kidney disease (CKD) patients with and without Heart failure (HF) are at risk of developing hyperkalaemia (HK), which is further heightened with the necessary use of renin–angiotensin–aldosterone system inhibitor (RAASi) therapy. Current standard of care (SoC) for HK is limited and often necessitates RAASi down-titration/discontinuation, resulting in detrimental outcomes. This study assessed the cost-effectiveness of patiromer for HK treatment in CKD patients with and without HF in an Italian setting.

METHODS:

A Markov cohort model was developed to assess the health economic impact of patiromer versus SoC after accounting for the effect of potassium levels and RAASi dose modification on clinical events. The model was based on the OPAL-HK trial with long-term data sourced mainly from Italian studies. Reported outcomes include incremental cost-effectiveness ratio (ICER), accumulated clinical events and number needed to treat (NNT). Subgroup analysis was conducted in CKD patients with and without HF. Model uncertainty was explored through deterministic and probabilistic sensitivity analysis.

RESULTS:

Patiromer treatment was associated with an incremental discounted cost of €3,602 and 0.167 quality adjusted life years (QALYs), yielding an ICER of €21,527 in comparison to SoC. Patiromer use resulted in 286 HK cases averted per 1,000 population and a NNT of 22. In subgroup analysis, patiromer was more effective in reducing the number of clinical events in CKD patients with HF versus without HF. Whilst, QALY gain was significantly less in CKD and HF group compared to CKD alone (0.062 versus 0.243, respectively). Scenario analysis and sensitivity analysis support base-case conclusions.

CONCLUSIONS:

Patiromer treatment was associated with cost savings and QALY gains in CKD patients with and without HF in an Italian setting. Patiromer was able to slow down CKD progression and prevent future HK events; enabling patients to maintain RAASi therapy and reduce their risk of cardiovascular events.