PMID- 30194623
OWN - NLM
STAT- MEDLINE
DCOM- 20190920
LR  - 20190920
IS  - 1179-2027 (Electronic)
IS  - 1170-7690 (Print)
IS  - 1170-7690 (Linking)
VI  - 36
IP  - 12
DP  - 2018 Dec
TI  - Cost-Effectiveness Analysis of Patiromer and Spironolactone Therapy in Heart 
      Failure Patients with Hyperkalemia.
PG  - 1463-1473
LID - 10.1007/s40273-018-0709-3 [doi]
AB  - BACKGROUND AND OBJECTIVE: Certain patients with heart failure (HF) are unable to 
      tolerate spironolactone therapy due to hyperkalemia. Patiromer is a novel agent 
      used to treat hyperkalemia and has been shown to be efficacious, safe, and 
      well-tolerated. The potential clinical outcomes and economic value of using 
      patiromer and spironolactone in patients with HF unable to otherwise tolerate 
      spironolactone due to hyperkalemia are unclear. The objective of this analysis 
      was to model the potential pharmacoeconomic value of using patiromer and 
      spironolactone in patients with a history of hyperkalemia that prevents them from 
      utilizing spironolactone. METHODS: We performed a cost-effectiveness analysis of 
      treatment with patiromer, spironolactone, and an angiotensin-converting enzyme 
      inhibitor (ACEI) in patients with New York Heart Association (NYHA) class III-IV 
      HF compared with ACEI alone. A Markov model was constructed to simulate a cohort 
      of 65-year-old patients diagnosed with HF from the payer perspective across the 
      lifetime horizon. Clinical inputs were derived from the RALES and OPAL-HK 
      randomized trials of spironolactone and patiromer, respectively. Utility 
      estimates and costs were derived from the literature and list prices. Outcomes 
      assessed included hospitalization, life expectancy, and quality-adjusted 
      life-years (QALYs), costs, and the incremental cost-effectiveness ratio (ICER). 
      One-way and probability sensitivity analyses were performed to test the 
      robustness of the model findings. RESULTS: Treatment with 
      patiromer-spironolactone-ACEI was projected to increase longevity compared with 
      ACEI alone (5.29 vs. 4.62 life-years gained, respectively), greater QALYs (2.79 
      vs. 2.60), and costs (US$28,200 vs. US$18,200), giving an ICER of US$52,700 per 
      QALY gained. The ICERs ranged from US$40,000 to US$85,800 per QALY gained in 
      1-way sensitivity analyses. CONCLUSION: Our results suggest that the use of 
      spironolactone-patiromer-ACEI may provide clinical benefit and good economic 
      value in patients with NYHA class III-IV HF unable to tolerate spironolactone due 
      to hyperkalemia.
FAU - Bounthavong, Mark
AU  - Bounthavong M
AD  - Department of Pharmacy, University of Washington, 1959 NE Pacific St, HSB H375-P, 
      Box 357630, Seattle, WA, 98195-7630, USA.
FAU - Butler, Javed
AU  - Butler J
AD  - Division of Cardiology, Stony Brook University, Stony Brook, NY, USA.
FAU - Dolan, Chantal M
AU  - Dolan CM
AD  - CMD Consulting, Sandy, UT, USA.
FAU - Dunn, Jeffrey D
AU  - Dunn JD
AD  - Magellan Rx, Salt Lake City, UT, USA.
FAU - Fisher, Kathryn A
AU  - Fisher KA
AD  - CMD Consulting, Sandy, UT, USA.
FAU - Oestreicher, Nina
AU  - Oestreicher N
AD  - Epidemiology, HEOR and Observational Research, Relypsa, Inc., a Vifor Pharma 
      Group Company, Redwood City, CA, USA.
AD  - Department of Clinical Pharmacy, University of California, San Francisco, CA, 
      USA.
FAU - Pitt, Bertram
AU  - Pitt B
AD  - University of Michigan School of Medicine, Ann Arbor, MI, USA.
FAU - Hauptman, Paul J
AU  - Hauptman PJ
AD  - Division of Cardiology, Department of Medicine, Saint Louis University School of 
      Medicine, Saint Louis, MI, USA.
FAU - Veenstra, David L
AU  - Veenstra DL
AD  - Department of Pharmacy, University of Washington, 1959 NE Pacific St, HSB H375-P, 
      Box 357630, Seattle, WA, 98195-7630, USA. veenstra@uw.edu.
LA  - eng
GR  - U54 GM115428/GM/NIGMS NIH HHS/United States
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - New Zealand
TA  - Pharmacoeconomics
JT  - PharmacoEconomics
JID - 9212404
RN  - 0 (Diuretics)
RN  - 0 (Polymers)
RN  - 1FQ2RY5YHH (patiromer)
RN  - 27O7W4T232 (Spironolactone)
EIN - Pharmacoeconomics. 2019 May 14;:. PMID: 31089966
MH  - Aged
MH  - Cost-Benefit Analysis
MH  - Diuretics/administration & dosage/economics
MH  - Economics, Pharmaceutical
MH  - Heart Failure/complications/*drug therapy/economics
MH  - Hospitalization/economics
MH  - Humans
MH  - Hyperkalemia/*drug therapy/economics/etiology
MH  - Markov Chains
MH  - Polymers/*administration & dosage/economics
MH  - Quality-Adjusted Life Years
MH  - Randomized Controlled Trials as Topic
MH  - Spironolactone/*administration & dosage/economics
MH  - Treatment Outcome
PMC - PMC6244629
COIS- Mark Bounthavong and David L. Veenstra report consulting relationships with 
      Relypsa, Inc., a Vifor Pharma Group Company. Javed Butler reports 
      consultancy/advisory board fees from Amgen, Array, AstraZeneca, Bayer, Boehringer 
      Ingelheim, Bristol-Myers Squibb, CVRx, G3 Pharmaceutical, Innolife, Janssen, 
      Luitpold, Medtronic, Merck, Novartis, Relypsa, Inc., a Vifor Pharma Group 
      Company, Stealth Peptide, SC Pharma, Vifor, and ZS Pharma; other research support 
      and research grants from European Union and the National Institutes of Health; 
      and speaker/honoraria from Novartis and Janssen. Chantal M. Dolan and Kathryn A. 
      Fisher are employees of CMD Consulting, and report consulting relationships with 
      Genentech Inc., Gilead Sciences, Halozyme Therapeutics, Iconic Therapeutics, 
      Semnur Pharmaceuticals and Relypsa, Inc., a Vifor Pharma Group Company. Jeffrey 
      A. Dunn reports consultancy/advisory board fees from Relypsa, Inc., a Vifor 
      Pharma Group Company. Nina Oestreicher reports previous employment by Relypsa, 
      Inc., a Vifor Pharma Group Company at the time of the study. Bertram Pitt reports 
      serving as a consultant to Sanofi, Relypsa, Merck, Bayer, AstraZeneca, 
      scPharmaceuticals, Tricida, KBP Biosciences, Stealth Peptides, Sarfez, and 
      AuraSense; stock options in scPharmaceuticals, Tricida, KBP Biosciences, Sarfez, 
      and AuraSense; serving on data safety monitoring committees for and receiving 
      personal fees from Johnson & Johnson; and, in addition, he has a pending patent 
      EFS ID 14916043, application number licensed to the University of Michigan School 
      of Medicine. Paul J. Hauptman reports consultant/advisory board fees, research 
      grants, and speaker/honoraria from Relypsa, Inc., a Vifor Pharma Group Company.
EDAT- 2018/09/09 06:00
MHDA- 2019/09/21 06:00
PMCR- 2018/09/08
CRDT- 2018/09/09 06:00
PHST- 2018/09/09 06:00 [pubmed]
PHST- 2019/09/21 06:00 [medline]
PHST- 2018/09/09 06:00 [entrez]
PHST- 2018/09/08 00:00 [pmc-release]
AID - 10.1007/s40273-018-0709-3 [pii]
AID - 709 [pii]
AID - 10.1007/s40273-018-0709-3 [doi]
PST - ppublish
SO  - Pharmacoeconomics. 2018 Dec;36(12):1463-1473. doi: 10.1007/s40273-018-0709-3.