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Abstract: TH-OR25

Comparative Effectiveness of Patiromer and RAAS Inhibitor Continuation vs. No Potassium Binder and Discontinued RAAS Inhibitors on Healthcare Resource Utilization and Cost Outcomes in Hyperkalemia

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

  • 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Rowan, Christopher G., COHRDATA, San Clemente, California, United States
  • Alvarez, Paula J., Vifor Pharma, Inc., Redwood City, California, United States
  • Golestaneh, Ladan, Albert Einstein College of Medicine, Bronx, New York, United States
  • Desai, Nihar, Yale University, Center for Outcomes Research and Evaluation, New Haven, Connecticut, United States
Background

Patiromer (PAT) is a sodium-free, non-absorbed potassium (K+) binder approved for treatment of hyperkalemia (HK). The objective of the study was to estimate relative cost of treating Medicare Advantage patients (pts) with HK with different therapeutic strategies.

Methods

This retrospective, propensity score–matched cohort study utilized the de-identified Optum Clinformatics® Data Mart (from 2016 to 2019). Two HK cohorts were identified: 1) pts exposed to PAT+RAASi therapy; and 2) pts who discontinued RAASi therapy (DC RAASi). All pts had serum K+ ≥5.0 mEq/L, HK diagnosis, and ≥6 mos insurance enrollment. Pts were propensity score matched on baseline characteristics. Relative healthcare spending rate (exposure contrast: PAT+RAASi vs DC RAASi [reference]) was analyzed at 3 mos using zero-inflated negative binomial regression. Cost outcomes included: total, inpatient, emergency department (ED), outpatient services, and outpatient pharmacy.

Results

Study cohorts included 464 pts (232 matched pairs). Overall, mean age was 74 yrs, 59% male, and 31% Hispanic. Pts had a mean of 5 comorbidities: CKD (95%), diabetes mellitus (73%), chronic heart failure (32%), cardiac arrhythmias (33%), and coronary artery disease (39%). At 3 mos, 168 pts (84 matched pairs) remained uncensored and were analyzed. Total healthcare spending rate for DC RAASi cohort was $15,344 vs $9135 (95% confidence interval, $6303, $13,241) for PAT+RAASi cohort over 3 mos (P<0.01; Figure) and was driven by marked reductions in outpatient and ED costs.

Conclusion

After 3 mos of PAT+RAASi therapy, relative total healthcare spending rate was 40% lower compared with pts not exposed to a K+ binder who discontinued RAASi to manage HK in matched Medicare Advantage pts. Study Limitation: Potential exposure misclassification via RAASi dispensings from generic pharmacy programs.

Funding

  • Commercial Support