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



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.


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.


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.


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.


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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.

Author information




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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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).

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