S115Even in ideal cases for PBMs, the switch to a biosimilar may lead to 25% lower rebate dollars unless an increase in utilization can compensate for the lower rebate amount. ConCluSionS: In the US, biosimilars need to navigate a complex marketplace of payers including insurance companies, pharmacy benefit managers and government payers as well as providers, prescribers and patients. One key success driver will be to overcome the financial hurdles put up by well-established originator products. Given the revenue dollars at stake, an originator is unlikely to eliminate rebates, but rather to increase rebates to attempt to maintain market share vs. a biosimilar entrant.
Introduction Hyperkalemia is associated with increased morbidity and mortality in patients with chronic kidney disease (CKD). Patiromer (Veltassa ® ) is an oral potassium binder indicated for the treatment of hyperkalemia in adults. We evaluated the impact of patiromer on the Swiss healthcare resources when used in patients with CKD and hyperkalemia who were on renin–angiotensin–aldosterone system inhibitor (RAASi) treatment. Methods We built a decision tree and calculated the number needed to treat (NNT) to prevent hyperkalemia, hospitalization, and death based on published aggregated data. The decision tree was populated with available data from relevant patiromer clinical trials and data were applied to create a simple model showing the expected effectiveness of adding patiromer to the treatment of patients with medium-to-severe stage CKD on RAASi compared to RAASi only. Adapting the model to the Swiss healthcare system allowed us to estimate the impact of the new treatment on healthcare expenditures from a payer as well as a Swiss public healthcare perspective. Results Patiromer reduced the absolute risk for recurrent hyperkalemia by 48% within 8 weeks, resulting in an NNT of 2.1 [95% CI 1.4, 3.7]. If one assumes that 90%, 50%, or 10% of all moderate-to-severe hyperkalemic events lead to hospitalization, the NNT to prevent one hospitalization would be 2.5, 4.4, and 22.2, respectively. On the basis of the death rate of patients with mild or moderate-to-severe hyperkalemia, and the prevalence of mild or moderate-to-severe hyperkalemia in the treatment and control groups, the NNT was 78.7 [95% CI 64.0, 99.3] to prevent one death. Patiromer resulted in expected cost offsets of CHF 303 (1 CHF = 0.95 EUR as of 2022) per patient over 8 weeks in Switzerland. Conclusion Patiromer used for the treatment of CKD reduces hyperkalemia recurrence leading to improved patient care. This results in substantial offset costs for the Swiss healthcare system. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02123-3.
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