1 Magellan Rx Management, Newport, Rhode Island.
3 Relypsa, Redwood City, California, and Department of Clinical Pharmacy, University of California, San Francisco.
J Manag Care Spec Pharm. 2017 Apr;23(4-a Suppl):S2-S9. doi: 10.18553/jmcp.2017.23.4-a.s2.
Hyperkalemia (HK) is a concern for patients with chronic kidney disease (CKD) and heart failure (HF), and for those receiving treatments that inhibit the renin-angiotensin-aldosterone system (RAASi). An analysis of 1.7 million medical records of patients in the United States revealed that among individuals with more than 2 potassium values during 2007 to 2012, HK was detected in 34.6% of patients with CKD and 30.0% of patients with HF.
To evaluate the association of HK and use of RAASi therapies at optimal and suboptimal doses in patients with CKD and/or HF with health care resource utilization and overall cost of care in a diverse cohort of commercially insured patients.
This retrospective cohort study was conducted using medical and pharmacy claims from multiple regional health plans. Qualifying patients were ≥ 18 years old, continuously enrolled for 6 months before and throughout the study period (January 1, 2014, to December 31, 2015) and had an ICD-9-CM or ICD-10-CM diagnosis code of CKD and/or HF. Health care resource utilization, including hospital visits, length of stay, office visits, and associated medical and pharmacy costs, were assessed according to the 3 cohorts (CKD alone, HF alone, and concomitant CKD and HF). For the 3 cohorts, the results were also compared between patients with and without HK and between patients with and without RAASi use at optimal and suboptimal doses. Generalized linear models were used to further examine the predictors of medical and overall costs.
In this study, 15,999 patients met inclusion criteria. Among patients using RAASi therapy, 26.8% received the optimal dose. Optimal dosing of RAASi was associated with decreased median outpatient office visits (8, 10, and 15, respectively, for patients with CKD, HF, and both CKD and HF) compared with suboptimal dosing of RAASi (12, 15, and 23, respectively). Similarly, optimal dosing of RAASi was associated with decreased overall median medical costs ($2,092, $4,144, and $7,762, respectively, for patients with CKD, HF, and both CKD and HF) compared with suboptimal dosing of RAASi ($3,121, $8,289, and $12,749, respectively). Patients with CKD, HF, or both CKD and HF, all in combination with HK, had higher overall costs, compared with those without HK.
The results of this real-world analysis suggest that HK and suboptimal dosing of RAASI were associated with a median increase in outpatient office visits as well as increased overall medical costs among patients with CKD and/or HF. This evaluation of median costs suggests effective HK management may potentially reduce costs in patients with CKD and/or HF, including those currently receiving RAASi therapy.
This study was conducted by Magellan Rx Management and funded by Relypsa. Brenner, Alvarez, and Oestreicher were employed by Relypsa during the development of this study and the writing of this manuscript. Polson, Lord, Kangethe, Speicher, and Farnum are employees of Magellan Rx Management, which received funding from Relypsa for conducting the retrospective study and writing the manuscript. Study concept and design were contributed by Lord, Polson, Brenner, Alvarez, and Oestreicher. Data collection and interpretation were performed by Polson and Kangethe, with assistance from Lord. The manuscript was written by Farnum, with assistance from Kangethe and Speicher and revised by all authors.
高钾血症（HK）是慢性肾脏病（CKD）和心力衰竭（HF）患者以及接受肾素-血管紧张素-醛固酮系统抑制剂（RAASi）治疗的患者的关注点。对美国 170 万份患者病历的分析显示，在 2007 年至 2012 年期间有两次以上血钾值的患者中，CKD 患者的 HK 检出率为 34.6%，HF 患者为 30.0%。
评估在接受 CKD 和/或 HF 治疗的患者中，HK 与 RAASi 治疗的最佳和次优剂量的相关性，以及在不同商业保险患者人群中，与医疗保健资源利用和总体治疗费用的关系。
本回顾性队列研究使用了来自多个地区健康计划的医疗和药房理赔数据。合格患者为年龄≥18 岁，在研究期间（2014 年 1 月 1 日至 2015 年 12 月 31 日）前 6 个月和整个研究期间连续入组，且有 ICD-9-CM 或 ICD-10-CM 诊断代码为 CKD 和/或 HF。根据 3 个队列（CKD 单独、HF 单独和 CKD 和 HF 同时存在）评估了医疗资源利用情况，包括住院就诊次数、住院天数、门诊就诊次数，以及相关的医疗和药房费用。对于这 3 个队列，还比较了有和无 HK 以及有和无 RAASi 最佳和次优剂量使用的患者的结果。使用广义线性模型进一步检查了医疗和总体费用的预测因素。
本研究共纳入了 15999 名符合条件的患者。在使用 RAASi 治疗的患者中，26.8%接受了最佳剂量。与 RAASi 的次优剂量相比，RAASi 的最佳剂量与降低门诊就诊次数中位数相关（分别为 CKD、HF 和 CKD 和 HF 患者的 8、10 和 15 次）。同样，与 RAASi 的次优剂量相比，RAASi 的最佳剂量与降低总体医疗费用中位数相关（分别为 CKD、HF 和 CKD 和 HF 患者的 2092、4144 和 7762 美元）。与无 HK 的患者相比，CKD、HF 或 CKD 和 HF 同时存在的患者的总体医疗费用更高。
本真实世界分析的结果表明，在 CKD 和/或 HF 患者中，HK 和 RAASI 的次优剂量与门诊就诊次数中位数增加以及总体医疗费用增加相关。对中位数成本的评估表明，有效的 HK 管理可能会降低包括目前正在接受 RAASi 治疗的患者在内的 CKD 和/或 HF 患者的成本。
本研究由 Magellan Rx Management 进行，由 Relypsa 资助。Brenner、Alvarez 和 Oestreicher 在开展这项研究和撰写这份手稿期间受雇于 Relypsa。Polson、Lord、Kangethe、Speicher 和 Farnum 是 Magellan Rx Management 的员工，该公司因进行回顾性研究和撰写手稿而从 Relypsa 获得了资金。Lord、Polson、Brenner、Alvarez 和 Oestreicher 提出了研究概念和设计。Polson 和 Kangethe 进行了数据收集和解释，Lord 提供了协助。Farnum 撰写了这份手稿，Kangethe 和 Speicher 提供了协助，所有作者都对其进行了修订。
