OBJECTIVES: To perform a cost-effectiveness evaluation from the perspective of the Mexican Health System (MHS), of the use of sodium zirconium cyclosilicate (SZC) for the treatment of hyperkalemia (HK) in patients with chronic kidney disease (CKD) and/or heart failure (HF).

METHODS: SZC lower serum potassium (K+) levels in patients with HK from the first 48 hours and in the long term. This effect is consistent between patients with CKD, HF, and diabetes mellitus, by use of renin-angiotensin-aldosterone system inhibitors (RAASi) and by baseline serum K+.

A cost-effectiveness evaluation was performed using a patient-level, fixed-time increment stochastic simulation designed to predict the natural history of disease in patients with CKD and/or HF, and quantify the costs and benefits associated with using SZC for serum K+ management. In addition, treatment-specific K+ trajectories are modelled at the patient-level, and linked to the risk of fatal and nonfatal events. A lifetime horizon was considered.

In the acute phase of HK, SZC was added to standard of care (SoC), and compared with SoC alone. There were no direct medical costs associated with the long-term treatment of HK due to the SoC changes in lifestyle and diet.

RESULTS: SZC presents greater efficacy in terms of life years gained (4.3 y) compared with SoC (2.9y). The incremental cost associated with SZC vs SoC was $12,269.66. The incremental cost-effectiveness ratio ($9,128.41) was lower than 1 GDP per capita ($9,984.20). These results were consistent with the base case, in deterministic and probabilistic sensitivity analyses.

CONCLUSIONS: SZC should be considered a cost-effective alternative for treating HK in patients with CKD and/or HF, in the MHS.