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Abstract: PO1684

Cost Effectiveness Study of Hyperkalemia Management

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Desai, Nihar, Yale University, Center for Outcomes Research and Evaluation, New Haven, Connecticut, United States
  • Rowan, Christopher G., COHRDATA, Santa Monica, California, United States
  • Alvarez, Paula J., Relypsa, Inc., a Vifor Pharma Group Company, Redwood City, California, United States
  • Fogli, Jeanene, Relypsa, Inc., a Vifor Pharma Group Company, Redwood City, California, United States
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
Background

Patiromer (PAT) is a sodium-free, non-absorbed potassium (K+) binder approved for the treatment of hyperkalemia (HK). There is limited real-world evidence on the cost implications associated with PAT treatment of HK. The objective of this study was to assess the cost-effectiveness of treating HK with PAT vs. no K+ binder in a Medicare Advantage population.

Methods

This retrospective, matched cohort study was conducted using the de-identified Optum Clinformatics® Data Mart Database from 1/1/16–12/31/18. Two HK cohorts were identified: PAT exposed and unexposed (NoPAT). Patient inclusion criteria included pre-index serum K+ ≥5.0 mEq/L and HK diagnosis (ICD-10 code) and ≥6 months insurance enrollment post-index. Propensity score matching and coarsened exact matching with baseline variables were used to identify the complete set of matching unexposed and exposed HK episodes. Follow-up began on index date and ended at the first censoring event (insurance disenrollment, death, 12/31/18, sodium polystyrene sulfonate or sodium zirconium cyclosilicate initiation, PAT discontinuation [exposed only], PAT initiation [unexposed only]). Cost outcomes measured at 6 months post-index: total, inpatient, emergency department (ED), outpatient services and outpatient pharmacy (mean US$ [CI 95%]).

Results

The study population was 2004 patients (1002 matched pairs). Overall, mean age was 74 years and 60% were male. Patients had a mean of 5 comorbidities. Comorbidities included: DM (73%), CHF (35%), and ESRD (10%). At 6 months post-index, 300 (150 matched pairs) PAT and NoPAT patients remained uncensored. Total PAT mean cost difference (savings) of $7220 ($2211,$9584) was observed at 6 months post-index (P<0.01). This cost difference included a pharmacy increase of $3094 ($3964,$2224) and a decrease in medical costs, specifically, inpatient $4718 ($2222,$7215), outpatient $4781 ($2274,$7288), and ED $815 ($488,$1142).

Conclusion

At 6 months post-index, PAT cohort observed a 27% reduction in cost compared with the unexposed cohort for HK management. Further study is warranted to replicate these findings in a large cohort.