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Cost-Effectiveness Analysis of Patiromer in Combination with Renin–Angiotensin–Aldosterone System Inhibitors for Chronic Kidney Disease in Sweden

Author

Listed:
  • Julia Widén

    (Quantify Research AB)

  • Magnus Ivarsson

    (Vifor Pharma Nordiska AB)

  • Lovisa Schalin

    (Vifor Pharma Nordiska AB)

  • Polina Vrouchou

    (Vifor Pharma Ltd)

  • Matthias Schwenkglenks

    (Institute of Pharmaceutical Medicine (ECPM), University of Basel)

  • Olof Heimbürger

    (Karolinska University Hospital
    CLINTEC, Karolinska Institutet)

  • Zanfina Ademi

    (Institute of Pharmaceutical Medicine (ECPM), University of Basel
    Monash University)

  • C. Simone Sutherland

    (Institute of Pharmaceutical Medicine (ECPM), University of Basel)

Abstract

Objectives Patients with chronic kidney disease (CKD) are commonly treated with renin–angiotensin–aldosterone system inhibitors (RAASi) in order to delay progression of renal disease. However, research has shown that RAASi in CKD patients increases hyperkalaemia (HK) prevalence, which leads to RAASi discontinuation or dose reduction with the loss of benefits on the kidney. Patiromer is a novel therapy for HK treatment and may enable patients to remain on their RAASi regimen. This study aimed to assess the cost-effectiveness of patiromer from a Swedish healthcare perspective. Methods A Markov model was developed to evaluate the economic outcomes of patiromer versus no patiromer in HK patients with stage 3–4 CKD taking RAASi. The model consisted of six health states reflecting disease progression and hospitalisations. The analysis mainly considered clinical data from the OPAL-HK trial and national costs. The main outcomes of interest were incremental costs (euro [EUR] 2016) and quality-adjusted life years (QALYs), discounted at 3%, and the incremental cost-effectiveness ratio (ICER). Extensive uncertainty analyses were performed. Results In comparison to no patiromer, a patiromer patient gained 0.14 QALYs and an incremental cost of EUR 6109 (Swedish krona [SEK] 57,850), yielding an ICER of EUR 43,307 (SEK 410,072)/QALY gained. The results were robust to a range of sensitivity analyses. At a willingness-to-pay threshold of EUR 52,804 (SEK 500,000)/QALY, patiromer had a 50% chance of being cost-effective. Conclusions The results indicate that patiromer may demonstrate value for money in Swedish patients with stage 3–4 CKD, by enabling RAASi treatment. However, there is a considerable degree of uncertainty.

Suggested Citation

  • Julia Widén & Magnus Ivarsson & Lovisa Schalin & Polina Vrouchou & Matthias Schwenkglenks & Olof Heimbürger & Zanfina Ademi & C. Simone Sutherland, 2020. "Cost-Effectiveness Analysis of Patiromer in Combination with Renin–Angiotensin–Aldosterone System Inhibitors for Chronic Kidney Disease in Sweden," PharmacoEconomics, Springer, vol. 38(7), pages 747-764, July.
  • Handle: RePEc:spr:pharme:v:38:y:2020:i:7:d:10.1007_s40273-020-00902-w
    DOI: 10.1007/s40273-020-00902-w
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    References listed on IDEAS

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    1. Melanie Wyld & Rachael Lisa Morton & Andrew Hayen & Kirsten Howard & Angela Claire Webster, 2012. "A Systematic Review and Meta-Analysis of Utility-Based Quality of Life in Chronic Kidney Disease Treatments," PLOS Medicine, Public Library of Science, vol. 9(9), pages 1-10, September.
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