Kleinman Analytic Solutions, LLC, Paso Robles, California.
CSL Vifor, Redwood City, California.
Kidney360. 2024 Aug 1;5(8):1101-1105. doi: 10.34067/KID.0000000000000483. Epub 2024 Jun 5.
Prior research suggests differences in rates of heart failure hospitalization or serious emergency department visits between patients on patiromer versus sodium zirconium cyclosilicate. Total costs of heart failure–related hospitalizations and emergency department visits may be lower in patients on patiromer compared with sodium zirconium cyclosilicate.
Previous work suggested differences between patients taking patiromer or sodium zirconium cyclosilicate (SZC) in real-world risk of heart failure (HF) hospitalizations and edema hospitalizations or emergency department (ED) visits (edema events). We further investigated these differences to assess economic importance. Retrospective study using published event rates and mean costs derived from Optum's deidentified Clinformatics Data Mart Database.
We designed a model to estimate adjusted economic offsets that combined respective patiromer and SZC HF hospitalization (25.1 and 35.8; difference 10.7 [95% confidence interval (CI), 2.6 to 18.8]) and edema event (3.4 and 7.1; difference 3.6 [95% CI, 1.7 to 7.1]) rates/100 person-years from the original published work with costs from our parallel data extract spanning 2019–2021, adjusted to 2021 US dollars.
In a base case of mean HF hospitalization, edema event, and 30-count potassium-binder prescription costs from our data extract, the estimated mean savings with patiromer was $1428 per person per year (95% CI, −$1508 to $4652). Respective costs per person per year for patiromer versus SZC were $8526 versus $12,622 (difference $4096 [95% CI, $116 to $7320]) for HF hospitalization and edema events, and $10,649 versus $7981 (difference −$2668) for potassium binders, totaling $19,175 for patiromer versus $20,603 for SZC.
With differing drug costs, hospitalization and ED costs offset this difference when event rates were numerically small. Model outcomes were driven by HF hospitalization cost and least influenced by edema ED visit cost. A limitation was that the Clinformatics Data Mart data extract may differ from the original work.
先前的研究表明，与服用硅酸锆钠环糊精相比，使用帕替洛默的患者心力衰竭住院或严重急诊科就诊的比率存在差异。与硅酸锆钠环糊精相比，使用帕替洛默的患者心力衰竭相关住院和急诊科就诊的总成本可能更低。
先前的研究表明，在真实世界中，服用帕替洛默或硅酸锆钠环糊精（SZC）的患者心力衰竭（HF）住院和水肿住院或急诊科就诊（水肿事件）的风险存在差异。我们进一步研究了这些差异，以评估其经济重要性。这是一项使用 Optum 的匿名 Clinformatics Data Mart 数据库中公布的事件率和平均成本进行的回顾性研究。
我们设计了一个模型，将先前发表的研究中各自的帕替洛默和 SZC HF 住院率（25.1 和 35.8；差异 10.7 [95%置信区间（CI），2.6 至 18.8]）和水肿事件率（3.4 和 7.1；差异 3.6 [95% CI，1.7 至 7.1]）与我们的平行数据提取中的成本进行了结合，该数据提取覆盖了 2019 年至 2021 年，并根据我们的研究进行了调整2021 年美元。
在我们数据提取的平均 HF 住院、水肿事件和 30 计数钾结合剂处方成本的基本情况下，使用帕替洛默的估计平均节省额为每人每年 1428 美元（95%CI，−1508 至 4652 美元）。帕替洛默与 SZC 相比，每人每年的相应费用分别为 8526 美元和 12622 美元（差异为 4096 美元[95%CI，116 至 7320 美元]）用于 HF 住院和水肿事件，10649 美元和 7981 美元（差异为−2668 美元）用于钾结合剂，总计帕替洛默为 19175 美元，而 SZC 为 20603 美元。
在药物成本不同的情况下，当事件率较小时，住院和 ED 成本会抵消这一差异。模型结果主要取决于 HF 住院治疗成本，受水肿 ED 就诊成本的影响最小。一个限制是 Clinformatics Data Mart 数据提取可能与原始研究不同。
