Cost-Effectiveness Analysis of Patiromer in Combination with Renin–Angiotensin–Aldosterone System Inhibitors for Chronic Kidney Disease in Sweden

Abstract

Objectives

Patients with chronic kidney disease (CKD) are commonly treated with renin–angiotensin–aldosterone system inhibitors (RAASi) in order to delay progression of renal disease. However, research has shown that RAASi in CKD patients increases hyperkalaemia (HK) prevalence, which leads to RAASi discontinuation or dose reduction with the loss of benefits on the kidney. Patiromer is a novel therapy for HK treatment and may enable patients to remain on their RAASi regimen. This study aimed to assess the cost-effectiveness of patiromer from a Swedish healthcare perspective.

Methods

A Markov model was developed to evaluate the economic outcomes of patiromer versus no patiromer in HK patients with stage 3–4 CKD taking RAASi. The model consisted of six health states reflecting disease progression and hospitalisations. The analysis mainly considered clinical data from the OPAL-HK trial and national costs. The main outcomes of interest were incremental costs (euro [EUR] 2016) and quality-adjusted life years (QALYs), discounted at 3%, and the incremental cost-effectiveness ratio (ICER). Extensive uncertainty analyses were performed.

Results

In comparison to no patiromer, a patiromer patient gained 0.14 QALYs and an incremental cost of EUR 6109 (Swedish krona [SEK] 57,850), yielding an ICER of EUR 43,307 (SEK 410,072)/QALY gained. The results were robust to a range of sensitivity analyses. At a willingness-to-pay threshold of EUR 52,804 (SEK 500,000)/QALY, patiromer had a 50% chance of being cost-effective.

Conclusions

The results indicate that patiromer may demonstrate value for money in Swedish patients with stage 3–4 CKD, by enabling RAASi treatment. However, there is a considerable degree of uncertainty.

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Data Availability Statement

The data that support the findings of this study are available from Vifor Pharma Ltd, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with the permission of Vifor Pharma Ltd.

References

  1. 1.

    Mortality GBD, Causes of Death C, Wang H, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459–544.

    Google Scholar 

  2. 2.

    Rosenberg M. Overview of the management of chronic kidney disease in adults. UpToDate. 2019. https://www.uptodate.com/contents/overview-of-the-management-of-chronic-kidney-disease-in-adults. Accessed 03 Mar 2019.

  3. 3.

    European Dialysis and Transplant Association. Chronic kidney disease – a challenge for European Healthcare Systems. 2015. http://www.era-edta2015.org/press/1_150526_18.00_Press%20Release_CKD_Challenge.pdf. Accessed 05 Mar 2019.

  4. 4.

    Gasparini A, Evans M, Coresh J, et al. Prevalence and recognition of chronic kidney disease in Stockholm healthcare. Nephrol Dial Transplant. 2016;31:2086–94.

    CAS  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Luyckx VA, Tonelli M, Stanifer JW. The global burden of kidney disease and the sustainable development goals. Bull World Health Organ. 2018;96:414-22D.

    Google Scholar 

  6. 6.

    European Kidney Health Alliance (EKHA). Policy Options for Kidney Health in Europe: Is kidney disease really such an important issue for Europe? 2012. https://www.era-edta.org/images/2012_EKHA-policy_paper.pdf. Accessed 05 Mar 2019.

  7. 7.

    von Zur-Mühlen B, Wintzell V, Levine A, et al. Healthcare resource use, cost, and sick leave following kidney transplantation in Sweden: a population-based, 5-year, retrospective study of outcomes: COIN. Ann Transplant. 2018;23:852–66.

    Google Scholar 

  8. 8.

    Brück K, Stel VS, Gambaro G, et al. CKD prevalence varies across the European general population. J Am Soc Nephrol JASN. 2016;27:2135–47.

    PubMed  Google Scholar 

  9. 9.

    Lundström UH, Gasparini A, Bellocco R, et al. Low renal replacement therapy incidence among slowly progressing elderly chronic kidney disease patients referred to nephrology care: an observational study. BMC Nephrol. 2017;18:59.

    PubMed  PubMed Central  Google Scholar 

  10. 10.

    Eriksson JK, Neovius M, Jacobson SH, et al. Healthcare costs in chronic kidney disease and renal replacement therapy: a population-based cohort study in Sweden. BMJ Open. 2016;6:e012062.

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    Rosano GMC, Tamargo J, Kjeldsen KP, et al. Expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors: coordinated by the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology. Eur Heart J Cardiovasc Pharmacother. 2018;4:180–8.

    PubMed  Google Scholar 

  12. 12.

    Bandak G, Sang Y, Gasparini A, et al. Hyperkalemia after initiating renin-angiotensin system blockade: the Stockholm Creatinine Measurements (SCREAM) project. J Am Heart Assoc. 2017;6:e005428.

    PubMed  PubMed Central  Google Scholar 

  13. 13.

    Kidney Disase Improving Global O. KDIGO 2012 Clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150.

    Google Scholar 

  14. 14.

    Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37:2129–200.

    PubMed  Google Scholar 

  15. 15.

    Thomsen RW, Nicolaisen SK, Adelborg K, et al. Hyperkalaemia in people with diabetes: occurrence, risk factors and outcomes in a Danish population-based cohort study. Diabet Med. 2018;35:1051–60.

    CAS  PubMed  Google Scholar 

  16. 16.

    Thomsen RW, Nicolaisen SK, Hasvold P, et al. Elevated potassium levels in patients with congestive heart failure: occurrence, risk factors, and clinical outcomes. J Am Heart Assoc. 2018;7:e008912.

    PubMed  PubMed Central  Google Scholar 

  17. 17.

    Almulhim AS, Hall E, Mershid Al Rehaili B, et al. Sodium polystyrene sulfonate induced intestinal necrosis; a case report. Saudi Pharm J. 2018;26:771–4.

    PubMed  PubMed Central  Google Scholar 

  18. 18.

    FASS [Farmaceutiska specialiteter i Sverige]. Resonium [Resonium] (in Swedish). 2018. https://www.fass.se/LIF/product?nplId=19640525000017&userType=0. Accessed 05 Mar 2019.

  19. 19.

    Usta Y, Ramirez C, Dennert B. Emphysematous gastritis and necrosis as a result of orally ingested sodium polystyrene sulfonate (Kayexalate) in sorbitol. Am J Gastroenterol. 2016;111:309-09.

    Google Scholar 

  20. 20.

    Chaitman M, Dixit D, Bridgeman MB. Potassium-binding agents for the clinical management of hyperkalemia. P & T Peer Rev J Formul Manag. 2016;41:43–50.

    Google Scholar 

  21. 21.

    Administration UFaD. Kayexalate (sodium polystyrene) [package insert]. Bridgewater: sanofi-aventis US LLC; 2010.

  22. 22.

    EMA. European public assessment report (EPAR) for Veltassa. 2017. http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/004180/human_med_002141.jsp&mid=WC0b01ac058001d124. Accessed 08 Feb 2019.

  23. 23.

    Bakris GL, Pitt B, Weir MR, et al. Effect of patiromer on serum potassium level in patients with hyperkalemia and diabetic kidney disease: the AMETHYST-DN randomized clinical trial. JAMA. 2015;314:151–61.

    CAS  PubMed  Google Scholar 

  24. 24.

    Pitt B, Anker SD, Bushinsky DA, et al. Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial. Eur Heart J. 2011;32:820–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Pitt B, Bakris GL, Weir MR, et al. Long-term effects of patiromer for hyperkalaemia treatment in patients with mild heart failure and diabetic nephropathy on angiotensin-converting enzymes/angiotensin receptor blockers: results from AMETHYST-DN. ESC Heart Fail. 2018;5:592–602.

    PubMed  PubMed Central  Google Scholar 

  26. 26.

    Weir MR, Bakris GL, Bushinsky DA, et al. Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. N Engl J Med. 2015;372:211–21.

    PubMed  Google Scholar 

  27. 27.

    Weir MR, Bushinsky DA, Benton WW, et al. Effect of patiromer on hyperkalemia recurrence in older chronic kidney disease patients taking RAAS inhibitors. Am J Med. 2018;131(555–64):e3.

    Google Scholar 

  28. 28.

    US Food and Drug Administration. Veltassa (Patiromer) powder for oral suspension. 2015. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2015/205739Orig1s000TOC.cfm. Accessed 05 Dec 2019.

  29. 29.

    EMA. Veltassa: EPAR—Public Assessment Report. 2017. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR__Public_assessment_report/human/004180/WC500232691.pdf. Accessed 08 Feb 2019.

  30. 30.

    European Medicines Agency. Veltassa (patiromer): product and publication details. 2017. https://www.ema.europa.eu/en/medicines/human/EPAR/veltassa. Accessed 03 Mar 2018.

  31. 31.

    Adarkwah CC, Gandjour A, Akkerman M, et al. To treat or not to treat? Cost-effectiveness of ace inhibitors in non-diabetic advanced renal disease—a Dutch perspective. Kidney Blood Press Res. 2013;37:168–80.

    PubMed  Google Scholar 

  32. 32.

    Hogan TJ, Elliott WJ, Seto AH, et al. Antihypertensive treatment with and without benazepril in patients with chronic renal insufficiency: a US economic evaluation. Pharmacoeconomics. 2002;20:37–47.

    CAS  PubMed  Google Scholar 

  33. 33.

    Ruggenenti P, Pagano E, Tammuzzo L, et al. Ramipril prolongs life and is cost effective in chronic proteinuric nephropathies. Kidney Int. 2001;59:286–94.

    CAS  PubMed  Google Scholar 

  34. 34.

    Schadlich PK, Brecht JG, Brunetti M, et al. Cost effectiveness of ramipril in patients with non-diabetic nephropathy and hypertension: economic evaluation of Ramipril Efficacy in Nephropathy (REIN) Study for Germany from the perspective of statutory health insurance. Pharmacoeconomics. 2001;19:497–512.

    CAS  PubMed  Google Scholar 

  35. 35.

    Van Hout BA, Simeon GP, McDonnell J, et al. Economic evaluation of benazepril in chronic renal insufficiency. Kidney Int Suppl. 1997;51:S159–62.

    Google Scholar 

  36. 36.

    Vegter S, Perna A, Hiddema W, et al. Cost-effectiveness of ACE inhibitor therapy to prevent dialysis in nondiabetic nephropathy: influence of the ACE insertion/deletion polymorphism. Pharmacogenet Genom. 2009;19:695–703.

    CAS  Google Scholar 

  37. 37.

    Adarkwah CC, Gandjour A. Cost–effectiveness of angiotensin-converting enzyme inhibitors in nondiabetic advanced renal disease. Expert Rev Pharmacoecon Outcomes Res. 2011;11:215–23.

    PubMed  Google Scholar 

  38. 38.

    Little DJ, Nee R, Abbott KC, et al. Cost-utility analysis of sodium polystyrene sulfonate vs. potential alternatives for chronic hyperkalemia. Clin Nephrol. 2014;81:259–68.

    PubMed  Google Scholar 

  39. 39.

    Smith DH, Raebel MA, Chan KA, et al. An economic evaluation of a laboratory monitoring program for renin-angiotensin system agents. Med Decis Mak Int J Soc Med Decis Mak. 2011;31:315–24.

    Google Scholar 

  40. 40.

    Bounthavong M, Butler J, Dolan CM, et al. Cost-effectiveness analysis of patiromer and spironolactone therapy in heart failure patients with hyperkalemia. PharmacoEconomics. 2018;36:1463–73.

    PubMed  PubMed Central  Google Scholar 

  41. 41.

    The Dental and Pharmaceutical Benefits Agency [Tandvårds- och läkemedelsförmånsverket, TLV]. Veltassa is included in the benefits scheme with restricted reimbursement [Veltassa ingår i högkostnadsskyddet med begränsning] (in Swedish). 2018. https://www.tlv.se/beslut/beslut-lakemedel/begransad-subvention/arkiv/2018-05-21-veltassa-ingar-i-hogkostnadsskyddet-med-begransning.html. Accessed 10 Oct 2018.

  42. 42.

    The Swedish Renal Registry. Prevalence of hyperkalaemia among patients with chronic kidney disease treated with RAAS inhibitors - Data on file. 2017.

  43. 43.

    Vifor Fresenius Medical Care. Patriomer study 301 posthoc analyses for pricing dossiers 16AUG2016 (exploratory findings from OPAL HK). Data on file. 2016.

  44. 44.

    Sutherland C, Braunhofer P, Vrouchou P, et al. A cost-utility analysis of raasi enabling-patiromer in patients with hyperkalemia. Value Health. 2017;20:A490.

    Google Scholar 

  45. 45.

    Vemer P, Corro Ramos I, van Voorn GAK, et al. AdViSHE: a validation-assessment tool of health-economic models for decision makers and model users. PharmacoEconomics. 2016;34:349–61.

    CAS  PubMed  Google Scholar 

  46. 46.

    Husereau D, Drummond M, Petrou S, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS)-explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health. 2013;16:231–50.

    PubMed  Google Scholar 

  47. 47.

    Xie X, Liu Y, Perkovic V, et al. Renin-angiotensin system inhibitors and kidney and cardiovascular outcomes in patients with CKD: a Bayesian network meta-analysis of randomized clinical trials. Am J Kidney Dis. 2016;67:728–41.

    CAS  PubMed  Google Scholar 

  48. 48.

    The Pharmaceutical Benefits Board. General guidelines for economic evaluations from the Pharmaceutical Benefits Board (LFNAR 2003:2). 2003. https://www.tlv.se/download/18.2e53241415e842ce95514e9/1510316396792/Guidelines-for-economic-evaluations-LFNAR-2003-2.pdf. Accessed 15 Apr 2017.

  49. 49.

    Statistics Sweden [Statistikmyndigheten SCB]. Life table by sex and age. Year 1960–2019 [Ettårig livslängdstabell för hela riket efter kön och ålder. År 1960–2019] (in Swedish). 2016. http://www.statistikdatabasen.scb.se/pxweb/en/ssd/START__BE__BE0101__BE0101I/LivslangdEttariga/. Accessed 05 Dec 2016.

  50. 50.

    Eriksen BO, Ingebretsen OC. The progression of chronic kidney disease: a 10-year population-based study of the effects of gender and age. Kidney Int. 2006;69:375–82.

    CAS  PubMed  Google Scholar 

  51. 51.

    Steenkamp R, Caskey F. UK Renal Registry 18th Annual Report: Chapter 6 Comorbidities and current smoking status amongst patients starting renal replacement therapy in England, Wales and Northern Ireland from 2013 to 2014. Nephron. 2016;132(Suppl 1):145–54.

    PubMed  Google Scholar 

  52. 52.

    Jones-Hughes TST, Haasova M, Coelho H, Crathorne L, Cooper C, et al. Immunosuppressive therapy for kidney transplantation in adults: a systematic review and economic model. Health Technol Assess (Winchester, England). 2016;20:1–594.

    PubMed Central  Google Scholar 

  53. 53.

    Ara R, Brazier J. Populating an economic model with health state utility values: moving toward better practice. Value Health. 2010;13:509–18.

    PubMed  Google Scholar 

  54. 54.

    Craig R, Mindell, J., eds. Health survey for England 2012: health, social care and lifestyles. Leeds: Health and Social Care Information Centre. 2012. http://doc.ukdataservice.ac.uk/doc/7480/mrdoc/pdf/7480userguide.pdf. Accessed 24 Sep 2018.

  55. 55.

    Swedish Association of Local Authorities and Regions. Cost-per-patient (KPP) database. 2015. https://statva.skl.se/KPP_somatik_publik.html. Accessed 15 Apr 2017.

  56. 56.

    Farmaceutiska specialiteter i Sverige [FASS]. Stockholm: FASS; 2017. https://www.fass.se/LIF/startpage. Accessed 15 Apr 2017.

  57. 57.

    Southern Region of Health [Södra Regionvårdsnämnden]. Regional prices and remunerations for the Southern Region of Health 2017 [Regionala priser och ersättningar för södra sjukvårdsregionen 2017] (in Swedish). 2017. https://sodrasjukvardsregionen.se/download/regionala-priser-och-ersattningar-for-sodra-sjukvardsregionen-2017/. Accessed 24 Sep 2018.

  58. 58.

    Häkkinen U, et al. Outcome, use of resources and their relationship in the treatment of AMI, stroke and hip fracture at European hospitals. Health Econ. 2015;24:116–39.

    PubMed  Google Scholar 

  59. 59.

    EuroStat. Harmonised index of consumer prices (HICP). 2017. https://ec.europa.eu/eurostat/web/hicp/data/database. Accessed 20 Mar 2019.

  60. 60.

    European Central Bank. ECB euro reference exchange rate: Swedish krona (SEK). 2019. https://www.ecb.europa.eu/stats/policy_and_exchange_rates/euro_reference_exchange_rates/html/eurofxref-graph-sek.en.html. Accessed 20 Mar 2019.

  61. 61.

    Chatoth D, Wahl P, Rakov V, et al. mp608 Real-world outcomes of hyperkalemia management with patiromer in end-stage renal disease patients undergoing hemodialysis in the United States. Nephrol Dial Transplant. 2017;32:iii657.

    Google Scholar 

  62. 62.

    Pergola PE, Spiegel DM, Warren S, et al. Patiromer lowers serum potassium when taken without food: comparison to dosing with food from an open-label, randomized, parallel group hyperkalemia study. Am J Nephrol. 2017;46:323.

    CAS  PubMed  PubMed Central  Google Scholar 

  63. 63.

    OECD. Population (indicator), https://doi.org/10.1787/d434f82b-en. https://data.oecd.org/sweden.htm. Accessed 25 Nov 2019.

  64. 64.

    DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42:200–9.

    PubMed  Google Scholar 

  65. 65.

    Shirazian S, Grant CD, Mujeeb S, et al. Underprescription of renin-angiotensin system blockers in moderate to severe chronic kidney disease. Am J Med Sci. 2015;349:510–5.

    PubMed  Google Scholar 

  66. 66.

    Burnier M, Pruijm M, Wuerzner G, et al. Drug adherence in chronic kidney diseases and dialysis. Nephrol Dial Transplant. 2015;30:39–44.

    CAS  PubMed  Google Scholar 

  67. 67.

    Muntner P, Judd SE, Krousel-Wood M, et al. Low medication adherence and hypertension control among adults with CKD: data from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Am J Kidney Dis. 2010;56:447–57.

    PubMed  PubMed Central  Google Scholar 

  68. 68.

    Naderi SH, Bestwick JP, Wald DS. Adherence to drugs that prevent cardiovascular disease: meta-analysis on 376,162 patients. Am J Med. 2012;125(882–7):e1.

    Google Scholar 

  69. 69.

    The National Board of Health and Welfare [Socialstyrelsen]. National guidelines for diabetes care 2010 [Nationella riktlinjer för diabetesvård 2010] (in Swedish). Stockholm: The National Board of Health and Welfare. 2010.

  70. 70.

    The National Board of Health and Welfare [Socialstyrelsen]. National guidelines for cardiac care 2015 [Nationella riktlinjer för hjärtsjukvård 2015] (in Swedish). Stockholm: The National Board of Health and Welfare. 2015.

  71. 71.

    Bounthavong M, Adamson R, Dolan C, et al. Cost-effectiveness of patiromer for hyperkalemia in CKD patients using RAASIs—nephrology times. Florida: AMCP; 2018.

    Google Scholar 

  72. 72.

    US Food and Drug Administration. FDA webinar: webinar draft guidance for industry (GFI) On enrichment strategies for clinical trials to support approval Of human drugs and biological products – March 25, 2013. 2013. https://www.fda.gov/drugs/fda-webinar-webinar-draft-gfi-enrichment-strategies-clinical-trials-support-approval-human-drugs-and. Accessed 28 Jan 2018.

  73. 73.

    U.S. National Library of Medicine. The effects of patiromer on serum potassium level and gut microbiome of ESRD patients with hyperkalemia. 2017. https://clinicaltrials.gov/ct2/show/NCT03326583. Accessed 30 Mar 2019.

  74. 74.

    U.S. National Library of Medicine. Patiromer efficacy to reduce episodic hyperkalemia in end stage renal disease patients. 2018. https://clinicaltrials.gov/ct2/show/NCT03781089. Accessed 30 Mar 2019.

  75. 75.

    U.S. National Library of Medicine. Pharmacokinetic study of tacrolimus and mycophenolate mofetil in kidney transplant recipients with hyperkalemia receiving patiromer. 2017. https://clinicaltrials.gov/ct2/show/NCT03229265. Accessed 30 Mar 2019.

  76. 76.

    U.S. National Library of Medicine. Patiromer for the management of hyperkalemia in subjects receiving RAASi medications for the treatment of heart failure (DIAMOND). https://clinicaltrials.gov/ct2/show/NCT03888066. Accessed 30 May 2019.

  77. 77.

    Landray MJ, Emberson JR, Blackwell L, et al. Prediction of ESRD and death among people with CKD: the Chronic Renal Impairment in Birmingham (CRIB) prospective cohort study. Am J Kidney Dis. 2010;56:1082–94.

    PubMed  PubMed Central  Google Scholar 

  78. 78.

    Morel OEGS, Jesel L, Radulescu B, Meyer N, Wiesel ML, et al. Cardiovascular mortality in chronic kidney disease patients undergoing percutaneous coronary intervention is mainly related to impaired P2Y12 inhibition by clopidogrel. J Am Coll Cardiol. 2011;57:399–408.

    CAS  PubMed  Google Scholar 

  79. 79.

    Ariyaratne TVAZ, Duffy SJ, Andrianopoulos N, Billah B, Brennan AL, et al. Cardiovascular readmissions and excess costs following percutaneous coronary intervention in patients with chronic kidney disease: data from a large multi-centre Australian registry. Int J Cardiol. 2013;168:2783–90.

    PubMed  Google Scholar 

  80. 80.

    Luo JBS, Jensen DE, Yang A. Association between serum potassium and outcomes in patients with reduced kidney function. Clin J Am Soc Nephrol. 2016;11:90–100.

    CAS  PubMed  Google Scholar 

  81. 81.

    Tuso P. Choosing wisely and beyond: shared decision making and chronic kidney disease. Perm J. 2013;17:75.

    PubMed  PubMed Central  Google Scholar 

  82. 82.

    Kerr MBB, Medcalf J, O’Donoghue DJ, Matthews B. Estimating the financial cost of chronic kidney disease to the NHS in England. Nephrol Dial Transplant. 2012;27:73–80.

    Google Scholar 

  83. 83.

    Dunn JD, Benton WW, Orozco-Torrentera E, et al. The burden of hyperkalemia in patients with cardiovascular and renal disease. Am J Manag Care. 2015;21:s307–15.

    PubMed  Google Scholar 

  84. 84.

    Wyld MMR, Hayen A, Howard K, Webster AC. A systematic review and meta-analysis of utility-based quality of life in chronic kidney disease treatments. PLoS Med. 2012;9:e1001307.

    PubMed  PubMed Central  Google Scholar 

  85. 85.

    Thokala PBH, Brennan A, Pandor A, Stevens JW, Gomersall T, et al. Telemonitoring after discharge from hospital with heart failure: cost-effectiveness modelling of alternative service designs. BMJ Open. 2013;3:e003250.

    PubMed  PubMed Central  Google Scholar 

  86. 86.

    Taylor MSP, Chaplin S, Papo NL. An economic evaluation of valsartan for post-MI patients in the UK who are not suitable for treatment with ACE inhibitors. Value Health. 2009;12:459–65.

    PubMed  Google Scholar 

  87. 87.

    Liem YSBJ, Hunink MG. Preference-based quality of life of patients on renal replacement therapy: a systematic review and meta-analysis. Value Health. 2008;4:733–41.

    Google Scholar 

  88. 88.

    Wald ASC, Kamm MA, Mueller-Lissner S, Helfrich I, Schuijt C, et al. The burden of constipation on quality of life: results of a multinational survey. Aliment Pharmacol Ther. 2007;26:227–36.

    CAS  PubMed  Google Scholar 

  89. 89.

    Tengs TOWA. One thousand health-related quality-of-life estimates. Med Care. 2000;38:583–637.

    CAS  PubMed  Google Scholar 

  90. 90.

    Sud M, Tangri N, Pintilie M, et al. Progression to Stage 4 chronic kidney disease and death, acute kidney injury and hospitalization risk: a retrospective cohort study. Nephrol Dial Transplant. 2016;31:1122–30.

    PubMed  Google Scholar 

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Acknowledgements

We would like to thank Georgiana Cornea and Michele Intorcia for writing and editing assistance and for contributing their insights and knowledge related to patiromer and its use in the Swedish setting.

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Contributions

CSS, ZA and MS designed the original model with input and direction from PV. JW adapted the model to a Swedish setting and analysed the data. MI, LS and PV supervised the Swedish model adaptation and were in charge of overall direction and planning. OH contributed with knowledge related to patiromer and its use in the Swedish setting. CSS and JW wrote the manuscript with input from all authors.

Corresponding author

Correspondence to Julia Widén.

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Funding

This study was funded by Vifor Pharma Ltd.

Conflict of interest

Julia Widén received consultancy fees from Vifor Pharma Ltd. to complete the reported analysis. Polina Vrouchou, Lovisa Schalin and Magnus Ivarsson were employed by Vifor Pharma Ltd. or one of its subsidiaries at the time of the analysis. Dr. C. Simone Sutherland, Dr. Zanfina Ademi and Prof. Dr. Matthias Schwenkglenks have received funding from Vifor Pharma Ltd. to develop the model that was used in this analysis. Dr. Olof Heimbürger has received lecture honoraria from Adcock Ingram Intensive Care, Astra-Zeneca, Baxter, Fresenius and Vifor Pharma Ltd. He has also participated on advisory boards of Astra-Zeneca, Opterion, Vifor Pharma Ltd. and taken part in clinical trials with Astra-Zeneca, Bayer, Glaxo Smith Kline, Otsuka and Triomed.

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Widén, J., Ivarsson, M., Schalin, L. et al. Cost-Effectiveness Analysis of Patiromer in Combination with Renin–Angiotensin–Aldosterone System Inhibitors for Chronic Kidney Disease in Sweden. PharmacoEconomics 38, 747–764 (2020). https://doi.org/10.1007/s40273-020-00902-w

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