Orlando—Renin-angiotensin-aldosterone system inhibitors (RAASIs) are of benefit to patients with chronic kidney disease (CKD); however, providers may avoid or discontinue use of RAAIs due to concerns related to RAASI-induced hyperkalemia. Patiromer is a non-absorbed potassium-binding polymer for the treatment of hyperkalemia, including patients on RAASIs.
Mark Bounthavong, PharmD, MPH, and colleagues recently conducted a study to assess the cost-effectiveness of patiromer in combination with a RAASI for patients with CKD. They reported results of the study during a poster session at AMCP Nexus 2018 in a poster titled The Cost-Effectiveness Analysis of Patiromer and Renin-Angiotensin-Aldosterone System Inhibitors Therapy in Diabetic Nephropathy Patients with Hyperkalemia.
Lifetime costs and quality-adjusted life years (QALYs) for patients with CKD were simulated with a Markov model. The researchers estimated the incremental cost-effectiveness ratio (ICER, cost per QALY gained) for treatment with a RAASI with patiromer (treatment arm) versus use of a RAASI alone (control). Data from the US Renal Data System (USRDS) and existing literature were used to derive transition probabilities for developing end-stage renal disease (ESRD) and mortality. Total direct costs for drug treatment, transplantation, and dialysis were derived from wholesale acquisition costs, USRDS, and the literature, respectively. ICER less than $100,000 per QALY gained was considered cost-effective.
Treatment with a RAASI in combination with patiromer resulted in 6.32 QALYs, versus 5.97 QALYs for the control arm (incremental of QALY of ~0.35). Total direct costs for the treatment arm were $265,400 compared with $246,800 for the control arm. The ICER was $53,400 per QALY gained.
The lifetime increase in drug cost of $55,600 was partially offset by a decrease in dialysis costs of $36,500. Major drivers in the model were the reduction in relative risk of ESRD with RAASI treatment, patiromer drug cost, and cost and quality of life associated with ESRD. Varying model parameters did not lead to an ICER above $100/QALY unless the ESRD relative risk reduction with RAASI treatment was less than 28%.
In conclusion, the researchers said, “Our modeled analysis suggests use of patiromer with RAASI treatment in CKD patients otherwise unable to tolerate RAASI treatment due to hyperkalemia appears to show gains in life expectancy and quality of life, as well as cost savings from decreasing the risk of ESRD and dialysis. These findings may help decision makers develop policies around patiromer by providing information on potential long-term incremental clinical and economic outcomes.”