Medical Costs in Patients with Hyperkalemia on Long-Term Sodium Zirconium Cyclosilicate Therapy: The RECOGNIZE II Study

Abstract

Abiy Agiro,1 Jamie P Dwyer,2 Yemisi Oluwatosin,3 Pooja Desai3 1US Evidence, US Medical Affairs, AstraZeneca, Wilmington, DE, USA; 2Department of Internal Medicine, University of Utah Health, Salt Lake City, UT, USA; 3US Renal, US Medical Affairs, AstraZeneca, Wilmington, DE, USACorrespondence: Abiy Agiro, AstraZeneca, US Medical Affairs, 1800 Concord Pike, Wilmington, DE, 19850, USA, Tel [phone], Email [email protected]: Hyperkalemia, defined as abnormally high serum potassium levels of ≥ 5.1 mmol/L, is associated with increased medical costs. This real-world study evaluated the impact of long-term sodium zirconium cyclosilicate (SZC) therapy on medical costs in patients with hyperkalemia.Patients and Methods: This retrospective, comparative study used claims data from IQVIA PharMetrics® Plus. Patients aged ≥ 18 years with hyperkalemia who had outpatient SZC fills (> 3-month supply over 6 months) between July 2019 and December 2021 and continuous insurance coverage 6 months before and 6 months after the first SZC fill were included. These patients (SZC cohort) were 1:1 exact- and propensity score-matched on baseline variables with patients with hyperkalemia who did not receive SZC (non-SZC cohort). The primary endpoint was hyperkalemia-related medical costs to payers over 6 months.Results: Each cohort included 661 matched patients. Mean per-patient hyperkalemia-related medical costs were reduced by 49.5% ($3728.47) for the SZC versus non-SZC cohort ($3798.04 vs $7526.51; P 3 months) outpatient treatment with SZC was associated with medical cost savings compared with no SZC therapy.Plain Language Summary: Hyperkalemia, in which potassium levels in the blood are abnormally high, can lead to significant health issues, including life-threatening heart problems. Patients with kidney disease, heart failure, high blood pressure, and diabetes have an increased risk of experiencing hyperkalemia. It can also be caused by a group of drugs, known as renin-angiotensin-aldosterone system inhibitors (RAASis), that is a key part of treatment for conditions including heart failure and high blood pressure. Sodium zirconium cyclosilicate (SZC) is a treatment for hyperkalemia that lowers potassium levels and, by doing so, can also allow patients to continue taking RAASis. Our aim was to evaluate the effect of long-term (> 3 months) SZC treatment on medical costs (sum of costs for inpatient hospital treatment, emergency department visits, and outpatient treatment) paid by health insurance. We compared medical costs over 6 months for patients with hyperkalemia treated with SZC with those for a matching group of patients with hyperkalemia who did not receive SZC (non-SZC group). We found that the average hyperkalemia-related medical cost for each patient was reduced by $3728.47 (49.5%) for patients treated with SZC versus the non-SZC group. The average medical cost per patient for all causes was also lower for patients treated with SZC, with a reduction of $5492.20 (21.0%); this was larger than the increase in average pharmacy cost per patient of $3621.03 (39.8%) for the SZC versus non-SZC group. Our study shows that long-term treatment with SZC is associated with lower medical costs compared with no SZC treatment.Graphical Abstract: Keywords: anti-hyperkalemia therapy, elevated blood potassium, healthcare resource utilization, pharmacoeconomics, potassium binder, real-world evidence

Keywords

• anti-hyperkalemia therapy
• elevated blood potassium
• healthcare resource utilization
• pharmacoeconomics
• potassium binder
• real-world evidence