OBJECTIVES: Hyperkalaemia (HK) increases the risk of major adverse cardiovascular events (MACE) and mortality. Patients with heart failure (HF) or chronic kidney disease (CKD) are susceptible to HK due to impaired renal function, older age, comorbidities, and concomitant medications. This study aimed to develop a novel cost-effectiveness model to estimate cost and health outcomes associated with effective HK management in HF or CKD.

METHODS: A lifetime patient-level simulation was developed in Microsoft Excel. Disease progression was modelled in HF via progression through New York Heart Association (NYHA) classes and in CKD via continuous estimated glomerular filtration rate (eGFR) decline, leading to end-stage renal disease (ESRD). Time-dependent potassium (K+) trajectories were simulated utilising mixed-effects regression equations and linked to mortality, hospitalisation, MACE and changes in renin-angiotensin-aldosterone system inhibitor use via published risk ratios. Two hypothetical scenarios were evaluated from a UK payer perspective, independent of long-term K+ management costs: lifetime maintenance of normokalaemia (NK) compared to fluctuating K+ levels resulting in HK rates consistent with clinical practice. Published utilities and disease costs (2015) were applied and discounted at 3.5%.

RESULTS: In patients aged 60 at baseline with CKD (eGFR=50 ml/min/1.73m) predicted life expectancy (LE), quality-adjusted life years (QALYs) and total costs (TC) were 9.0 years, 6.7 QALYs and £69,606 in the NK group compared to 8.6 years, 6.3 QALYs and £65,231 in the HK group. Increased survival to ESRD drove higher estimated TC in the NK group. In patients aged 60 at baseline with HF (NYHA III) predicted LE, QALYs and TC were 7.8 years, 5.6 QALYs and £7,881 in the NK group and 5.9 years, 4.3 QALYs and £6,374 in the HK group, respectively.

CONCLUSIONS: Optimising K+ management in CKD and HF patients has the potential to increase LE and QALYs, while influencing direct healthcare expenditure and allowing for an efficient use of resources.