OBJECTIVES: Patients with chronic kidney disease (CKD) with and without heart failure (HF), especially those receiving renin–angiotensin–aldosterone system inhibitors (RAASi), often present with hyperkalemia (HK), resulting in poorer clinical and economic outcomes. In the recent DIAMOND trial, patiromer significantly reduced potassium levels, mineralocorticoid receptor antagonist discontinuation or dose reductions, and HK events in patients with HF of whom > 40% had concomitant CKD Stage 3 or above. We analyzed results from DIAMOND to assess cost-effectiveness of patiromer versus standard of care (SoC) in Spain.

METHODS:

A published Markov model was updated to include data from DIAMOND, adapted to the Spanish setting, then used to estimate cost-effectiveness of treating HK with patiromer versus SoC. All patients received patiromer during a run-in period (up to 12 weeks), leaving a legacy effect of patiromer in the SoC arm during the placebo-controlled withdrawal phase. Therefore, indirect treatment comparison was conducted based on real world evidence to better represent SoC; mean potassium concentration for SoC and patiromer was calculated from the overall population at baseline (screening phase) and after treatment (end of run-in period), respectively. Spanish specific inputs were sourced from published literature and databases. Outcomes include total and incremental clinical events, quality adjusted life years (QALYs), life years (LYs), costs, incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (NMB).

RESULTS: Estimated life expectancy was greater in patients receiving patiromer compared to those receiving SoC (10.162 versus 8.110 [LYs], respectively). Patiromer treatment was associated with an incremental discounted cost of €37,428 and 1.610 incremental QALYs, yielding an ICER of €23,251 and an incremental NMB per person of €10,864 over a lifetime horizon.

CONCLUSIONS: Analysis from the DIAMOND study shows that patiromer is a cost-effective treatment option for management of HK in CKD with and without HF compared to SoC in Spain.