PUK17 - A COST-EFFECTIVENESS ANALYSIS OF RAASI – ENABLING PATIROMER FOR THE TREATMENT OF HYPERKALEMIA IN SWEDEN

Use of renin-angiotensin aldosterone inhibitors (RAASi) in patients with chronic kidney disease (CKD) reduces the risk of kidney failure and cardiovascular events. However, RAASi induce hyperkalemia (HK), which can result in reduction or discontinuation of RAASi dose and thus comprising the clinical and pharmacoeconomic benefits of RAASi. HK is associated with life-threatening cardiac arrhythmias and a significant economic burden driven by hospitalization. Patiromer is a novel therapy indicated for the treatment of HK, with the potential to enable concomitant RAASi treatment. This study aims to assess the cost-effectiveness of patiromer versus no patiromer in HK patients with CKD stages 3-4 on RAASi in Sweden. Patiromer is reimbursed in Sweden since May 2018. A previously developed Markov model was updated to evaluate the costs and effects of treatment with patiromer versus no patiromer in patients who continued or discontinued RAASi treatment following HK. The model consisted of six mutually exclusive health states reflecting disease progression and associated hospitalization events. The analysis was performed from a Swedish healthcare perspective, using a 3% discount rate. Clinical data were taken from the OPAL-HK trial and from published literature. The main outcomes of interest were incremental costs and quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio (ICER). Extensive sensitivity analyses were performed to assess the robustness of the obtained results. Patiromer compared to no patiromer resulted in 0.14 QALYs gained at an incremental cost of SEK 57,850, yielding an ICER of SEK 410,072 per QALY. The results were robust to a range of sensitivity analyses. At a willingness-to-pay threshold of SEK 500,000/QALY, patiromer had a 50% chance of being cost-effective compared to no patiromer. By enabling RAASi treatment, the results indicate that patiromer is potentially a cost-effective intervention for the treatment of HK in patients with CKD stages 3-4 in Sweden.