OBJECTIVES: Risk of real-world hospitalizations for heart failure (HHF), and edema hospitalizations or emergency department (ED) visits (edema events) were previously directly compared by Zhuo et al (J Card Fail 2022;28:1414–23) for patients on patiromer (PAT) or sodium zirconium cyclosilicate (SZC), and showed consistent numerical differences across all endpoints favoring PAT. Statistical significance was achieved on the secondary endpoint of edema events and in a subgroup of patients who did not have HF prior to index HHF event. These numeric differences warrant further investigation as they may have economic and/or clinical importance.

METHODS: We designed a model to estimate adjusted economic offsets that combined respective PAT and SZC HHF (25.1 and 35.8; difference 10.7 [95% CI 2.6–18.8]) and edema event (3.4 and 7.1; difference 3.6 [95% CI 1.7–7.1]) rates/100 person-years from Zhuo et al, with mean costs derived from Optum’s de-identified Clinformatics^® Data Mart (CDM) database (the database used by Zhuo et al): HHF ($31,186 [n=2,095,607]); edema events (hospitalization $37,651 [n=514,859]; ED $552 [n=441,342]); and 30-count mean K⁺ binder prescription costs (PAT $887 [n=34,578]; SZC $665 [n=13,181]). CDM data spanned 2019–2021, and costs were adjusted to 2021 US dollars.

RESULTS: For this base case, PAT was associated with a mean savings estimate of $142,844/100 person-years (95% CI –$150,816; $465,243). Respective costs/100 person-years for PAT vs SZC were $852,555 vs $1,262,195 (difference $409,640 [95% CI $115,980–732,039]) for HHF and edema events, and $1,064,928 vs $798,132 (difference –$266,796) for K⁺ binders, totaling $1,917,483 for PAT vs $2,060,327 for SZC.

CONCLUSIONS: This model demonstrates cost offset to drug price at relatively small numeric differences in event rates. Model outcomes were most affected by HHF cost and least influenced by edema ED visit cost. Limitation: CDM data extract may differ from that used by Zhuo et al.