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Hospitalization and Emergency Department Costs in Patiromer and Sodium Zirconium Cyclosilicate Users
Nihar R Desai1, Charuhas Thakar2, Tejas Desai3
1Yale School of Medicine, New Haven, Connecticut.
Insights
Patiromer demonstrated significant cost savings compared to sodium zirconium cyclosilicate in managing hyperkalemia, reducing overall healthcare expenses by 15% through lower hospitalization and emergency department visit costs.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Pharmacoeconomics
Background:
- A prior study indicated patiromer use was associated with lower rates of heart failure and edema-related events compared to sodium zirconium cyclosilicate.
- However, that study did not include cost data for these hyperkalemic treatments.
Purpose of the Study:
- To compare the total healthcare costs associated with patiromer versus sodium zirconium cyclosilicate for managing hyperkalemia.
- This analysis incorporates event rates and medication costs to determine overall economic impact.
Main Methods:
- Combined event rates from a previous EHR study with 2019-2021 Optum Clinformatics cost data.
- Calculated and compared per person-year costs for heart failure hospitalizations, edema hospitalizations, and edema ED visits.
- Adjusted all costs to 2024 US dollars for inflation and included medication expenses.
Main Results:
- Patiromer group costs per person-year: $30,269.05 (HFH), $2,520.13 (EH), $31.67 (ED).
- Sodium zirconium cyclosilicate group costs per person-year: $39,478.29 (HFH), $4,061.48 (EH), $51.04 (ED).
- Patiromer showed aggregated cost savings of $7,907.99 per person-year, representing a 15% reduction.
Conclusions:
- Total costs were $44,245 for patiromer and $52,153 for sodium zirconium cyclosilicate per person-year.
- Patiromer offers a 15% cost advantage, accounting for all events, medication, and inflation adjustments.
- These findings highlight patiromer's economic benefit in managing hyperkalemia.
Key Points:
This study shows a statistically significant 15% potential heart failure hospitalization and edema event cost savings among patiromer users. Annual costs were $52,153 in the sodium zirconium cyclosilicate cohort and $44,245 in the patiromer cohort, an annual difference of $7908 per person. In addition to clinical benefits, these results highlight financial implications for health plans, value-based care organizations, and patients.
Background:
A previous study using US electronic health records directly compared the risk of heart failure-related or edema-related hospitalizations and edema-related emergency department (ED) visits for hyperkalemic patients using patiromer or sodium zirconium cyclosilicate. Incidence rates for all three clinical outcomes favored patiromer, but the previous study did not capture costs.
Methods:
The current investigation combines the patiromer and sodium zirconium cyclosilicate cohort heart failure hospitalization and edema event rates from the previous study with mean event and prescription costs from 2019 to 2021 Optum Clinformatics data. The resulting heart failure-related and edema-related event and medication costs were then compared between patiromer and sodium zirconium cyclosilicate cohorts. We inflation-adjusted those to 2024 US dollars.
Results:
For patiromer, costs for heart failure hospitalizations, edema hospitalizations, and edema ED visits were $30,269.05, $2520.13, and $31.67 per person-year, respectively. For sodium zirconium cyclosilicate, costs for heart failure hospitalizations, edema hospitalizations, and edema ED visits were $39,478.29, $4061.48, and $51.04, respectively. Medication costs per person-year were $11,423.68 and $8561.71 for patiromer and sodium zirconium cyclosilicate, respectively. The aggregated cost savings with patiromer was $7907.99 per person-year (95% confidence interval, $5453.58 to $10,362.40) for all heart failure hospitalization and edema hospitalization and ED events, adjusted for both inflation and medication costs.
Conclusions:
Total event and medication costs were $44,245 in the patiromer cohort and $52,153 in the sodium zirconium cyclosilicate cohort. The $7908 difference represents a 15% (95% confidence interval, 10% to 20%) cost savings associated with patiromer from all events, including medication costs and adjusted for inflation.
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