Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, USA.
US Evidence, US Medical Affairs, AstraZeneca, 1800 Concord Pike, Wilmington, DE, 19850, USA.
Adv Ther. 2023 Nov;40(11):4777-4791. doi: 10.1007/s12325-023-02631-w. Epub 2023 Aug 22.
Patients receiving cardiorenal-protective renin-angiotensin-aldosterone system inhibitors (RAASis) are at increased risk of developing hyperkalemia, which is associated with increased medical costs. The aim of this study was to evaluate the impact of adding sodium zirconium cyclosilicate (SZC) therapy on 3-month medical costs in patients who experienced hyperkalemia while receiving RAASi therapy.
The retrospective OPTIMIZE II study used medical and pharmacy claims data from IQVIA PharMetrics Plus. Patients aged ≥ 18 years who received SZC (≥ 60 day supply over 3 months' follow-up) and continued RAASi between July 2019 and December 2021 (Continue RAASi + SZC cohort) were 1:1 exact and propensity score matched with patients who discontinued RAASi after hyperkalemia diagnosis and did not receive SZC (Discontinue RAASi + no SZC cohort). The primary outcome was hyperkalemia-related medical costs to payers over 3 months; all-cause medical and pharmacy costs were also analyzed.
In the Continue RAASi + SZC (n = 467) versus Discontinue RAASi + no SZC (n = 467) cohort, there were significant reductions in mean per-patient hyperkalemia-related medical costs (reduction of $2216.07; p = 0.01) and all-cause medical costs (reduction of $6102.43; p < 0.001); mean hyperkalemia-related inpatient medical costs and all-cause inpatient and emergency department medical costs were significantly reduced. The reduction in all-cause medical cost in the Continue RAASi + SZC cohort offset an increase in the mean per-patient all-cause pharmacy cost (increase of $3117.71; p < 0.001).
RAASi therapy has well-established cardiorenal benefits. In OPTIMIZE II, management of RAASi-induced hyperkalemia with SZC was associated with lower hyperkalemia-related and all-cause medical costs than RAASi discontinuation without SZC, demonstrating medical cost savings with maintaining RAASi therapy with SZC.
接受心脏肾保护作用的肾素-血管紧张素-醛固酮系统抑制剂（RAASi）治疗的患者发生高钾血症的风险增加，这与医疗费用增加有关。本研究的目的是评估在接受 RAASi 治疗时发生高钾血症的患者中添加硅酸锆钠（SZC）治疗对 3 个月医疗费用的影响。
回顾性 OPTIMIZE II 研究使用了 IQVIA PharMetrics Plus 的医疗和药房索赔数据。2019 年 7 月至 2021 年 12 月期间，年龄≥18 岁的接受 SZC（≥60 天疗程，3 个月随访）并继续接受 RAASi 治疗的患者（继续 RAASi+SZC 队列）与因高钾血症诊断后停止 RAASi 治疗且未接受 SZC 的患者（停止 RAASi+无 SZC 队列）进行了 1:1 精确和倾向评分匹配。主要结局是 3 个月内与支付方相关的高钾血症相关医疗费用；还分析了全因医疗和药房费用。
在继续 RAASi+SZC（n=467）与停止 RAASi+无 SZC（n=467）队列中，每位患者的高钾血症相关医疗费用均显著降低（降低 2216.07 美元；p=0.01），全因医疗费用也显著降低（降低 6102.43 美元；p<0.001）；高钾血症相关住院医疗费用和全因住院和急诊部门医疗费用均显著降低。继续 RAASi+SZC 队列中全因医疗费用的降低抵消了每位患者全因药房费用的平均增加（增加 3117.71 美元；p<0.001）。
RAASi 治疗具有明确的心脏肾益处。在 OPTIMIZE II 中，用 SZC 治疗 RAASi 引起的高钾血症与不使用 SZC 停止 RAASi 相比，与低钾血症相关的全因医疗费用降低，表明在 SZC 维持 RAASi 治疗时可节省医疗费用。
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