Abstract：
Chronic hyperkalemia has negative consequences in the medium and long term, and determines the suspension of nephro and cardioprotective drugs, such as renin-angiotensin-aldosterone system inhibitors (RAASi). There is an alternative to the suspension or dose reduction of these treatments: the administration of potassium chelators. The aim of this study is to estimate the economic impact of the use of patiromer in patients with chronic kidney disease (CKD) or heart failure (HF) and hyperkalemia in Spain.
The annual economic impact of the use of patiromer has been estimated from the perspective of the Spanish society. Two scenarios were compared: patients with CKD or HF and hyperkalemia treated with and without patiromer. The costs have been updated to 2020 euros, using the Health Consumer Price Index. Direct healthcare costs related to the use of resources (treatment with RAASi, CKD progression, cardiovascular events and hospitalization due to hyperkalemia), direct non-healthcare costs (informal care: costs derived from time dedicated by patient\'s relatives), the indirect costs (productivity loss), as well as an intangible cost (due to premature mortality) were considered. A deterministic sensitivity analysis was performed to validate the robustness of the study results.
The mean annual cost per patient in the scenario without patiromer is €9,834.09 and €10,739.37 in CKD and HF, respectively. The use of patiromer would lead to cost savings of over 30% in both diseases. The greatest savings in CKD come from the delay in the progression of CKD. While in the case of HF, 80.1% of these savings come from premature mortality reduction. The sensitivity analyses carried out show the robustness of the results, obtaining savings in all cases.
The incorporation of patiromer allows better control of hyperkalemia and, as a consequence, maintain treatment with RAASi in patients with CKD or HF. This would generate a 32% of annual savings in Spain (€3,127 in CKD; €3,466 in HF). The results support the positive contribution of patiromer to health cost in patients with only CKD or in patients with only HF.
The annual economic impact of the use of patiromer has been estimated from the perspective of the Spanish society. Two scenarios were compared: patients with CKD or HF and hyperkalemia treated with and without patiromer. The costs have been updated to 2020 euros, using the Health Consumer Price Index. Direct healthcare costs related to the use of resources (treatment with RAASi, CKD progression, cardiovascular events and hospitalization due to hyperkalemia), direct non-healthcare costs (informal care: costs derived from time dedicated by patient\'s relatives), the indirect costs (productivity loss), as well as an intangible cost (due to premature mortality) were considered. A deterministic sensitivity analysis was performed to validate the robustness of the study results.
The mean annual cost per patient in the scenario without patiromer is €9,834.09 and €10,739.37 in CKD and HF, respectively. The use of patiromer would lead to cost savings of over 30% in both diseases. The greatest savings in CKD come from the delay in the progression of CKD. While in the case of HF, 80.1% of these savings come from premature mortality reduction. The sensitivity analyses carried out show the robustness of the results, obtaining savings in all cases.
The incorporation of patiromer allows better control of hyperkalemia and, as a consequence, maintain treatment with RAASi in patients with CKD or HF. This would generate a 32% of annual savings in Spain (€3,127 in CKD; €3,466 in HF). The results support the positive contribution of patiromer to health cost in patients with only CKD or in patients with only HF.
摘要：
背景：慢性高钾血症在中长期具有负面影响，并确定肾和心脏保护药物的悬浮，如肾素-血管紧张素-醛固酮系统抑制剂(RAASi)。存在这些治疗的悬浮或剂量减少的替代方案:施用钾螯合剂。这项研究的目的是评估西班牙慢性肾病（CKD）或心力衰竭（HF）和高钾血症患者使用patiromer的经济影响。
方法：从西班牙社会的角度估算了使用patiromer的年度经济影响。比较了两种情况：CKD或HF和高钾血症患者使用和不使用Patiromer治疗。费用已更新为2020欧元，使用健康消费者价格指数。与资源使用相关的直接医疗费用(用RAASI治疗，CKD进展,高钾血症导致的心血管事件和住院)，直接非医疗费用(非正式护理：患者亲属专用时间产生的费用)，间接成本(生产率损失)，以及无形成本(由于过早死亡)被考虑。进行了确定性敏感性分析，以验证研究结果的稳健性。
结果：在没有患者的情况下，CKD和HF的每位患者的平均年费用为9,834.09欧元和10,739.37欧元，分别。patiromer的使用将导致在两种疾病中节省超过30%的成本。CKD的最大节省来自CKD进展的延迟。而在HF的情况下，这些节省的80.1%来自过早降低死亡率。进行的敏感性分析显示了结果的稳健性，在所有情况下都能节省费用。
结论：掺入patiromer可以更好地控制高钾血症，因此，CKD或HF患者维持RAASi治疗。这将为西班牙每年节省32％（CKD为3,127欧元；HF为3,466欧元）。结果支持仅CKD患者或仅HF患者对健康成本的积极贡献。
方法：从西班牙社会的角度估算了使用patiromer的年度经济影响。比较了两种情况：CKD或HF和高钾血症患者使用和不使用Patiromer治疗。费用已更新为2020欧元，使用健康消费者价格指数。与资源使用相关的直接医疗费用(用RAASI治疗，CKD进展,高钾血症导致的心血管事件和住院)，直接非医疗费用(非正式护理：患者亲属专用时间产生的费用)，间接成本(生产率损失)，以及无形成本(由于过早死亡)被考虑。进行了确定性敏感性分析，以验证研究结果的稳健性。
结果：在没有患者的情况下，CKD和HF的每位患者的平均年费用为9,834.09欧元和10,739.37欧元，分别。patiromer的使用将导致在两种疾病中节省超过30%的成本。CKD的最大节省来自CKD进展的延迟。而在HF的情况下，这些节省的80.1%来自过早降低死亡率。进行的敏感性分析显示了结果的稳健性，在所有情况下都能节省费用。
结论：掺入patiromer可以更好地控制高钾血症，因此，CKD或HF患者维持RAASi治疗。这将为西班牙每年节省32％（CKD为3,127欧元；HF为3,466欧元）。结果支持仅CKD患者或仅HF患者对健康成本的积极贡献。
