Hyperkalemia, defined as serum potassium level >5 mEq/L, can lead to life-threatening arrhythmias and sudden cardiac death. In patients with cardiorenal syndrome, the care for hyperkalemia becomes significantly complex. There are few data on the economic impact of care for hyperkalemia in patients with cardiorenal syndrome.
N.R. Desai, MD, MPH, and colleagues utilized real-word data to conduct a retrospective cohort study to examine the economic impact of hyperkalemia on patients with cardiorenal syndrome in Medicaid managed care population in the United States. Results of the study were reported in American Health & Drug Benefits [2019;12(7):352-361].
The study analyzed data from a Medicaid database from one state in southern United States. The data covered a 30-month period between 2013 and 2016. There total study cohort included 3563 patients; of those, 973 had hyperkalemia and 2590 did not have hyperkalemia (controls). Patients were matched based on age, comorbidities, and Medicaid eligibility status and duration. Inclusion criteria for patients in the hyperkalemia cohort were age ≥18 years, Medicaid-only insurance status, coded cardiorenal diagnosis, and a claim for hyperkalemia during the study period. Costs were determined using paid claims data.
Healthcare costs were reported as medical and pharmacy costs per member per year (PMPY). In the hyperkalemia group, mean healthcare costs were $56,002 compared with $23,653 in the control group. The cost differences were driven by medical costs accrued in the hyperkalemia and in the control cohorts ($49,648 PMPY and $18,399 PMPY, respectively). The two largest drivers of the medical cost variance were inpatient costs ($33,116 PMPY in the hyperkalemia cohort vs $10,629 PMPY in the control group), and dialysis costs ($2716 PMPY in the hyperkalemia group vs $810 PMPY in the control cohort). In the hyperkalemia group, the medical loss ratio was 552% compared with 260% for the control group. Both groups had revenue deficits to the health plan; the hyperkalemia cohort had double the medical loss ratio compared with the control cohort.
In conclusion, the researchers said, “The findings from this Medicaid managed care population suggest that hyperkalemia increases healthcare utilization and costs, which are primarily driven by the costs associated with inpatient care and dialysis. Our findings demonstrate that the Medicaid beneficiaries who have cardiorenal comorbidities accrue high costs to the Medicaid health plan, and these costs are even higher if a hyperkalemia diagnosis is present. The very high medical loss ratio for the hyperkalemia cohort in our analysis indicates that enhanced monitoring and management of patients with hyperkalemia should be considered.”