The increased costs for patients with recurrent hyperkalemia were driven by the increased inpatient medical cost of additional time spent in the hospital following recurrence.
When assessing the consequences of recurrent hyperkalemia on health care resource utilization and cost, investigators of the REVOLUTIONIZE III trial found there were large increases in all-cause medical costs and health care resource utilization after hyperkalemia recurrence in patients with chronic kidney disease (CKD), according to the authors of a poster presented at the American Society of Nephrology’s (ASN) 2023 Kidney Week Annual Meeting, taking place November 2 to 5 in Philadelphia, Pennsylvania. The authors explained that these findings illustrate that there is an unmet need for chronic management of hyperkalemia in patients with stage 3/4 chronic kidney disease, such as through treatment with long-term novel potassium binder therapies.
“This study suggests that patients who have recurrent hyperkalemia have increased health care resource utilization (admissions to the hospital, emergency department visits, and clinic visits) and higher medical costs compared with patients without recurrent hyperkalemia,” said Jamie Green, MD, MS, chair of the American Kidney Fund's Medical Affairs Committee, nephrologist with Geisinger Health System, and co-director of the Kidney Health Research Institute, in an interview with Pharmacy Times. “Increased health care resource utilization means more time spent in the hospital or at office visits rather than time spent doing the things patients want to be doing.”
To assess the impact of hyperkalemia recurrence on patients with CKD, investigators of the real-world REVOLUTIONIZE III trial looked at all-cause medical costs and health care resource utilization in patients with recurrent hyperkalemia, non-recurrent hyperkalemia, and normokalemia. Using the de-identified Market Clarity data, investigators selected patients aged 18 years or older with stage 3/4 CKD. Hyperkalemia was then classified as recurrent hyperkalemia or non-recurrent hyperkalemia using a claims-based algorithm. The investigators then propensity-score matched 1:1 with patients with recurrent hyperkalemia and with separate cohorts of patients with normokalemia and non-recurrent hyperkalemia.
The index dates for the analysis were the date of the first event of the index pair of hyperkalemia diagnosis with 1 or more serum K+ value (>5.0 mEq) within 7 days in the recurrent hyperkalemia and non-recurrent hyperkalemia cohorts, or a randomly-selected serum K+ lab value (3.5-5.0 mmol/L) in the normokalemia cohort. The study outcomes assessed were all-cause medical costs and health care resource utilization during a period of 12 months.
In total, there were 4549 matched pairs in the recurrent hyperkalemia vs normokalemia analysis and 1599 matched pairs in the recurrent hyperkalemia vs non-recurrent hyperkalemia analysis. In the recurrent hyperkalemia cohort, there was a significantly higher mean per-patient all-cause medical costs than the normokalemia cohort ($34,163 vs $15,175) and non-recurrent hyperkalemia cohort ($52,290 vs $38,233) during a period of 12 months.
Additionally, the investigators found that health care resource utilization rates were also significantly higher for the recurrent hyperkalemia cohorts compared to the other cohorts. The authors noted that the increased costs were found to be driven by increased inpatient medical costs in the recurrent hyperkalemia cohort vs the normokalemia cohort, as well as in the recurrent hyperkalemia cohort vs non-recurrent hyperkalemia cohort.
“Hospital stays are not just costly to the health system, but to patients as well,” Mike Spigler, vice president of Patient Services and Kidney Disease Education at the American Kidney Fund, said in an interview with Pharmacy Times. “Missed time from work, hospital deductibles, and childcare costs can devastate a family’s finances. If this can be avoided by simply managing the chronicity of a patient’s hyperkalemia, then it should be a focus of their health care team.”
Bakris GL, Agiro A, Greatsinger A. REVOLUTIONIZE III: Consequences of Recurrent Hyperkalemia on Healthcare Resource Utilization and Cost. Presented at: 2023 ASN/Kidney Week. November 2, 2023. Accessed November 2, 2023. https://www.asn-online.org/education/kidneyweek/2023/program-abstract.aspx?controlId=3931773