González-Juanatey José Ramón, González-Franco Álvaro, de Sequera Patricia, Valls Marta, Ramirez de Arellano Antonio, Pomares Elisenda, Nieves Diana
Servicio Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago De Compostela, Spain.
Servicio Medicina Interna, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain.
J Med Econ. 2022 Jan-Dec;25(1):640-649. doi: 10.1080/13696998.2022.2074193.
Renin-angiotensin-aldosterone system inhibitors (RAASi) therapy is commonly used to reduce the risk of death and to slow down disease progression in patients with chronic kidney disease (CKD), heart failure (HF) and hypertension. However, the cardio-renal benefits of RAASi therapy are also associated with an increased risk of hyperkalemia (HK), which may lead to dose reduction or discontinuation of therapy. Patiromer has demonstrated to reduce the risk of HK, which enables to maintain optimal doses of RAASi therapy. This study aimed to assess the cost-effectiveness of patiromer for the management of HK in CKD patients with and without HF in Spain.
A Markov model was developed to evaluate the costs and benefits of patiromer for the management of HK in patients with CKD stages 3-4 with and without HF treated with RAASi over a lifetime horizon. The main outcomes included total direct costs (€2021), quality-adjusted life-years (QALYs), life-years gained (LYG) and incremental cost-effectiveness ratio (ICER). Deterministic one-way and probabilistic sensitivity analyses were performed to assess the robustness of the results.
Patiromer was more effective compared to no patiromer (5.76 vs 5.57 QALYs; 7.73 vs 7.50 LYG), and resulted in an incremental cost of €3,574, yielding an ICER of €19,092/QALY gained and of €15,236/LYG. Sensitivity analyses suggested that the results were robust to changes in most input parameters.
Patiromer is a cost-effective intervention in maintaining normokalemia and enabling optimal RAASi therapy in patients with CKD stages 3-4 with and without HF in Spain.
肾素-血管紧张素-醛固酮系统抑制剂（RAASi）疗法常用于降低慢性肾脏病（CKD）、心力衰竭（HF）和高血压患者的死亡风险并减缓疾病进展。然而，RAASi疗法对心肾的益处也与高钾血症（HK）风险增加相关，这可能导致治疗剂量减少或停药。帕替罗姆已被证明可降低HK风险，从而能够维持RAASi疗法的最佳剂量。本研究旨在评估在西班牙，帕替罗姆用于管理合并或不合并HF的CKD患者HK的成本效益。
建立了一个马尔可夫模型，以评估帕替罗姆在整个生命周期内用于管理接受RAASi治疗的3-4期CKD合并或不合并HF患者HK的成本和效益。主要结局包括总直接成本（2021欧元）、质量调整生命年（QALYs）、获得的生命年（LYG）和增量成本效益比（ICER）。进行了确定性单因素和概率敏感性分析，以评估结果的稳健性。
与不使用帕替罗姆相比，帕替罗姆更有效（5.76 QALYs对5.57 QALYs；7.73 LYG对7.50 LYG），并导致增量成本3574欧元，ICER为每获得1个QALY 19,092欧元，每获得1个LYG 15,236欧元。敏感性分析表明，结果对大多数输入参数的变化具有稳健性。
在西班牙，对于3-4期合并或不合并HF的CKD患者，帕替罗姆是一种具有成本效益的干预措施，可维持血钾正常并实现最佳RAASi治疗。
