Related Experiment Video
Updated: Jul 1, 2025
5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats
Published on: April 4, 2025
Cost-effectiveness of sodium zirconium cyclosilicate for advanced chronic kidney patients in Singapore
Junxing Chay1, Jason C J Choo2, Eric A Finkelstein1
1Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
Insights
Sodium zirconium cyclosilicate (SZC) is a cost-effective treatment for hyperkalaemia (HK) in chronic kidney disease (CKD) patients. It offers improved outcomes and resource allocation within the Singapore health system.
Area of Science:
- Nephrology
- Pharmacoeconomics
- Health Technology Assessment
Background:
- Hyperkalaemia (HK) is a common complication in patients with chronic kidney disease (CKD) and heart failure, particularly those on renin-angiotensin-aldosterone system inhibitors (RAASi).
- Managing HK is crucial to allow continued use of RAASi, which are vital for managing CKD and heart failure.
- Sodium zirconium cyclosilicate (SZC) is a novel therapeutic agent for HK.
Purpose of the Study:
- To evaluate the cost-effectiveness of sodium zirconium cyclosilicate (SZC) compared to the standard of care for treating hyperkalaemia (HK) in advanced chronic kidney disease (CKD) patients.
- To assess the economic value of SZC from the perspective of the Singapore health system.
Main Methods:
- A microsimulation model was adapted to simulate patient trajectories, including potassium levels, CKD progression, and treatment changes.
- Effectiveness data were sourced from ZS-004 and ZS-005 clinical trials.
- Model parameters were localized using administrative and medical records from Singapore General Hospital.
Main Results:
- Sodium zirconium cyclosilicate (SZC) demonstrated cost-effectiveness, with an incremental cost-effectiveness ratio (ICER) of SGD 45,068 per QALY, below the willingness-to-pay threshold.
- SZC was found to be most cost-effective in patients with less severe CKD who were also using RAASi.
- Sensitivity analyses confirmed the robustness of these findings.
Conclusions:
- The study establishes the cost-effectiveness of SZC for treating hyperkalaemia (HK) in chronic kidney disease (CKD) patients.
- SZC has the potential to reduce HK risks and optimize renin-angiotensin-aldosterone system inhibitor (RAASi) therapy.
- Integrating SZC into the Singapore health system is recommended for improved patient outcomes and resource allocation.
Introduction:
Hyperkalaemia (HK) is prevalent among patients with chronic kidney disease (CKD) and chronic heart failure, especially if they are treated with renin-angiotensin-aldosterone system inhibitors (RAASi). This study evaluated the cost-effectiveness of a newly developed anti-HK therapy, sodium zirconium cyclosilicate (SZC), to the current standard of care for treating HK in advanced CKD patients from the Singapore health system perspective.
Methods:
We adapted a global microsimulation model to simulate individual patients' potassium level trajectories with baseline potassium ≥5.5 mmol/L, CKD progression, changes in treatment, and other fatal and non-fatal events. Effectiveness data was derived from ZS-004 and ZS-005 trials. Model parameters were localised using CKD patients' administrative and medical records at the Singapore General Hospital Department of Renal Medicine. We estimated the lifetime cost and quality-adjusted life years (QALYs) of each HK treatment, and the incremental cost-effectiveness ratio of SZC.
Results:
SZC demonstrated cost-effectiveness with an incremental cost-effectiveness ratsio of SGD 45 068 per QALY over a lifetime horizon, below the willingness-to-pay threshold of SGD 90 000 per QALY. Notably, SZC proved most cost-effective for patients with less severe CKD who were concurrently using RAASi. Sensitivity analyses confirmed the robustness of the findings, accounting for alternative parameter values and statistical uncertainty.
Conclusion:
This study establishes the cost-effectiveness of SZC as a treatment for HK, highlighting its potential to mitigate the risk of hyperkalaemia and optimise RAASi therapy. These findings emphasise the value of integrating SZC into the Singapore health system for improved patient outcomes and resource allocation.
More Related Videos
Related Concept Videos
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:22Heart Failure Drugs: Diuretics
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:28Antihypertensive Drugs: Potassium-Sparing Diuretics