Health Economics and Outcomes Research Ltd., Rhymney House Unit A Copse Walk Cardiff Gate Business Park, Cardiff, CF23 8RB, UK.
Health Economics Group, College of Medicine and Health, University of Exeter, Exeter, England.
BMC Nephrol. 2023 Mar 9;24(1):47. doi: 10.1186/s12882-023-03088-3.
Chronic kidney disease (CKD) patients with and without heart failure (HF) often present with hyperkalaemia (HK) leading to increased risk of hospitalisations, cardiovascular related events and cardiovascular-related mortality. Renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, the mainstay treatment in CKD management, provides significant cardiovascular and renal protection. Nevertheless, its use in the clinic is often suboptimal and treatment is frequently discontinued due to its association with HK. We evaluated the cost-effectiveness of patiromer, a treatment known to reduce potassium levels and increase cardiorenal protection in patients receiving RAASi, in the UK healthcare setting.
A Markov cohort model was generated to assess the pharmacoeconomic impact of patiromer treatment in regulating HK in patients with advanced CKD with and without HF. The model was generated to predict the natural history of both CKD and HF and quantify the costs and clinical benefits associated with the use of patiromer for HK management from a healthcare payer's perspective in the UK.
Economic evaluation of patiromer use compared to standard of care (SoC) resulted in increased discounted life years (8.93 versus 8.67) and increased discounted quality-adjusted life years (QALYs) (6.36 versus 6.16). Furthermore, patiromer use resulted in incremental discounted cost of £2,973 per patient and an incremental cost-effectiveness ratio (ICER) of £14,816 per QALY gained. On average, patients remained on patiromer therapy for 7.7 months, and treatment associated with a decrease in overall clinical event incidence and delayed CKD progression. Compared to SoC, patiromer use resulted in 218 fewer HK events per 1,000 patients, when evaluating potassium levels at the 5.5-6 mmol/l; 165 fewer RAASi discontinuation episodes; and 64 fewer RAASi down-titration episodes. In the UK, patiromer treatment was predicted to have a 94.5% and 100% chance of cost-effectiveness at willingness-to-pay thresholds (WTP) of £20,000/QALY and £30,000/QALY, respectively.
This study highlights the value of both HK normalisation and RAASi maintenance in CKD patients with and without HF. Results support the guidelines which recommend HK treatment, e.g., patiromer, as a strategy to enable the continuation of RAASi therapy and improve clinical outcomes in CKD patients with and without HF.
患有和不患有心力衰竭（HF）的慢性肾脏病（CKD）患者经常出现高钾血症（HK），导致住院风险增加、心血管相关事件和心血管相关死亡率增加。肾素-血管紧张素-醛固酮系统抑制剂（RAASi）治疗是 CKD 管理的主要治疗方法，可提供显著的心血管和肾脏保护。然而，由于其与 HK 相关，其在临床中的应用往往并不理想，并且经常停止治疗。我们评估了在英国医疗保健环境中，用于降低钾水平并增加接受 RAASi 治疗的患者心脏肾脏保护作用的帕替莫尔的成本效益。
生成了一个 Markov 队列模型，以评估在患有和不患有 HF 的晚期 CKD 患者中，使用帕替莫尔调节 HK 的药物经济学影响。该模型用于预测 CKD 和 HF 的自然史，并从英国医疗保健支付者的角度量化使用帕替莫尔进行 HK 管理的相关成本和临床效益。
与标准治疗（SoC）相比，使用帕替莫尔的经济评估导致了更多的折扣生命年（8.93 年比 8.67 年）和更多的折扣质量调整生命年（6.36 年比 6.16 年）。此外，使用帕替莫尔治疗导致每位患者的折扣成本增加 2973 英镑，增量成本效益比（ICER）为每获得一个质量调整生命年增加 14816 英镑。平均而言，患者接受帕替莫尔治疗的时间为 7.7 个月，治疗可降低整体临床事件发生率和延缓 CKD 进展。与 SoC 相比，当评估 5.5-6mmol/l 时的钾水平时，使用帕替莫尔可使每 1000 名患者的 HK 事件减少 218 次，减少 RAASi 停药发作 165 次，减少 RAASi 剂量下调发作 64 次。在英国，帕替莫尔治疗预计在愿意支付的阈值（WTP）为 20000 英镑/QALY 和 30000 英镑/QALY 时，有 94.5%和 100%的可能性具有成本效益。
本研究强调了在患有和不患有 HF 的 CKD 患者中，HK 正常化和 RAASi 维持的价值。结果支持了指南的建议，即治疗 HK，例如使用帕替莫尔，作为一种策略，以实现继续 RAASi 治疗并改善患有和不患有 HF 的 CKD 患者的临床结局。
