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Cost-Effectiveness Analysis of Patiromer and Spironolactone Therapy in Heart Failure Patients with Hyperkalemia

Mark Bounthavong1, Javed Butler2, Chantal M Dolan3

  • 1Department of Pharmacy, University of Washington, 1959 NE Pacific St, HSB H375-P, Box 357630, Seattle, WA, 98195-7630, USA.

Pharmacoeconomics
|September 9, 2018
PubMed

Insights

For heart failure patients unable to tolerate spironolactone due to hyperkalemia, adding patiromer offers improved longevity and quality-adjusted life-years (QALYs) at a cost-effective rate, suggesting good economic value.

Area of Science:

  • Pharmacoeconomics
  • Cardiology
  • Health Economics

Background:

  • Spironolactone is crucial for heart failure (HF) management but often limited by hyperkalemia.
  • Patiromer effectively manages hyperkalemia, enabling spironolactone use in intolerant patients.
  • The economic value of combining patiromer with spironolactone in HF requires evaluation.

Purpose of the Study:

  • To model the pharmacoeconomic value of using patiromer and spironolactone in HF patients with hyperkalemia.
  • To assess the cost-effectiveness of patiromer-spironolactone therapy versus standard care.

Main Methods:

  • A Markov model simulated lifetime costs and outcomes for 65-year-old NYHA class III-IV HF patients.
  • Data from RALES and OPAL-HK trials informed clinical inputs; literature and list prices provided cost and utility estimates.
  • Cost-effectiveness was determined by the incremental cost-effectiveness ratio (ICER) per QALY gained.

Main Results:

  • Patiromer-spironolactone-ACEI therapy increased life expectancy (5.29 vs. 4.62 years) and QALYs (2.79 vs. 2.60) compared to ACEI alone.
  • This combination increased costs (US$28,200 vs. US$18,200) with an ICER of US$52,700 per QALY gained.
  • Sensitivity analyses showed ICERs ranging from US$40,000 to US$85,800 per QALY.

Conclusions:

  • Spironolactone-patiromer-ACEI therapy offers clinical benefits for HF patients intolerant to spironolactone due to hyperkalemia.
  • This combination demonstrates good economic value from a payer perspective.
  • Patiromer facilitates spironolactone use, improving outcomes and cost-effectiveness in specific HF populations.
Abstract

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