Hyperkalemia management in heart failure and chronic kidney disease: a Spanish cost-effectiveness analysis of patiromer informed by the integrated DIAMOND trial and real-world evidence.

backgroundIn patients with heart failure (HF) and chronic kidney disease (CKD), particularly those treated with renin–angiotensin–aldosterone system inhibitors (RAASi), hyperkalemia (HK) is common, contributing to negative clinical and economic outcomes. The recent DIAMOND clinical trial (ClinicalTrials.gov: NCT03888066) reported that the use of patiromer led to a significant reduction in RAASi discontinuation or dose adjustment, serum potassium levels, and episodes of HK in patients with HF and coexisting CKD. This study analyzed data from the DIAMOND clinical trial and real-world evidence (RWE) to assess the cost-effectiveness of patiromer versus standard of care (SoC) for the treatment of hyperkalemia in patients with heart failure and concomitant chronic kidney disease in Spain. MATERIALS AND

methodsTo estimate cost-effectiveness of treating HK with patiromer versus SoC, a published Markov model was adjusted to the Spanish setting. Country-specific inputs were sourced, and health economic outcomes were evaluated.

resultsPatients receiving patiromer were projected to have longer life expectancy than those receiving SoC (10.162 versus 8.110 LYs, respectively). The use of patiromer treatment was estimated to provide an incremental discounted cost of €37,428 and 1.610 incremental QALYs, yielding an ICER of €23,251 per QALY gained. Due to the DIAMOND trial design, a legacy effect of patiromer was present in the SoC arm, causing low serum K+ levels compared with real-world values. To mitigate this, RWE was sought to better represent K+ levels in the SoC arm. Subsequently, a MAIC analysis was used to adjust the K+ levels in the DIAMOND and RWE populations at screening (baseline) and end of the run-in phase (patiromer arm) to improve the data used in the cost-effectiveness model.

conclusionsLong-term data from the DIAMOND trial and RWE demonstrates that patiromer is a cost-effective treatment option for the management of HK in patients with HF and concomitant CKD, compared to SoC in the Spanish healthcare setting. CLINICAL TRIAL NUMBER: Not applicable.