Psy115 - A Cost-Effectiveness Analysis of Raasi – Enabling Patiromer for the Treatment of Hyperkalemia in Austria

Abstract

lifetime horizon, with costs and outcomes discounted by 3.5% per year. Univariate and multivariate probabilistic sensitivity analyses are conducted to investigate parameter uncertainty. RESULTS: The incremental cost-effectiveness ratio (ICER) for vedolizumab is estimated at £21,620/QALY compared with CT. Sensitivity analyses showed that results are most sensitive to variation in the CT arm transition probabilities from the moderately-severely active state and from the remission state. The ICER was also sensitive to response assessed at week six rather than week 8 and efficacy based on GEMINI II only. When treatment with vedolizumab was continued for 2 or 3 years (instead of 1 year) the ICER increased to £24,695/QALY and £26,207/QALY respectively. The average probabilistic ICER shows vedolizumab to be £27,428/QALY gained (95% CI ICER of -£7,883 to £82,947). CONCLUSIONS: The economic model predicts that treatment with vedolizumab improves QALYs and is a cost-effective alternative to CT for patients who have inadequate response to CT and TNF-a antagonists. Vedolizumab has received positive recommendations from the National Institute for Health and Care Excellence (NICE) and the Scottish Medicines Consortium (SMC) for the CT and anti-TNF failure population. PSY115OBJECTIVES: An increase in blood-serum-potassium levels is common in patients with renal impairment or heart failure. Lifesaving RAAS-inhibitors (RAASi) such as ACE inhibitors, AT1 receptor-antagonists and aldosterone-blockers lead to a further rise in potassium levels. Discontinuation and downtitration of RAASi result in increased morbidity, as RAASi prolong the time to complete renal insufficiency. The purpose of this study was to extend the results of an 8-week OPALeHK RCT for patiromer, a nonabsorbed potassium-binder, that showed significant reduction in hyperkalaemia and RAASi dose maintenance in the patiromer group (94%) compared to no-patiromer (placebo) arm (44%). The analysis was performed from the Austrian healthcare-systems perspective. METHODS: A reported model by Sutherland et al. (2017), composed of a decision-tree and a Markov process, was used to simulate the treatment pathway of patients with chronic-kidney-disease (CKD). The short-term decision-tree estimates the proportion of CKD patients (potassium level, 5.0mmol/L) that continued/discontinued RAASi medication after hyperkalemia. The endpoint of the decision-tree was linked with to Markov model to simulate life-time follow-up. The model includes 6 states (stable CKD, CKD disease-progression, cardiovascular (CV) events, post CV event, hospitalization and death). The cohort definition was adopted from the OPALeHK trial. Monte-Carlo simulation accounted for uncertainty. Direct costs and life expectancy were obtained from local sources for 2018. QALYs and costs were discounted at 5% p.a. RESULTS: Over lifetime, costs and outcomes associated with patiromer would amount to 38,117.17V and achieve 5.48 QALYs. Costs with no treatment are 27,157.66V and obtain 4.90 QALYs. The results show that pati...

The Cost Effectiveness of Patiromer for the Treatment of Hyperkalaemia in Patients with Chronic Kidney Disease with and without Heart Failure in Ireland

“…Our results are in accordance with other European cost-effectiveness analyses, which indicate that patiromer offers value for money as a treatment option for HK in patients with CKD through RAASi enablement [ 87 , 88 ]. A study from a Swedish perspective reported that patiromer had a 50% chance of being cost effective in patients with stage 3–4 CKD aged above 65 years, by enabling RAASi treatment, yielding an incremental cost-effectiveness ratio of €43,307 [ 88 ].…”

“…A study from a Swedish perspective reported that patiromer had a 50% chance of being cost effective in patients with stage 3–4 CKD aged above 65 years, by enabling RAASi treatment, yielding an incremental cost-effectiveness ratio of €43,307 [ 88 ]. Similarly, another study evaluated patiromer use in patients with stages 3–4 CKD receiving RAASi treatment from an Austrian healthcare system perspective [ 87 ]. Authors reported a significant improvement in QALYs with 7 months in perfect health and an incremental cost-utility ratio of €18,979.23 in patients with CKD treated with patiromer versus no patiromer.…”

Hiperpotasemia Crónica: Impacto asistencial y económico en España

“…Walter E. et al (86) (Austria) Pacientes con ERC estadio 3-4 en tratamiento con iSRAA. 5,48 AVAC con patiromer y 4,90 AVAC sin patiromer.…”