TY - JOUR
T1 - Healthcare utilization and expenditures associated with hyperkalemia management
T2 - a retrospective study of Medicare Advantage patients
AU - Desai, Nihar R.
AU - Alvarez, Paula J.
AU - Golestaneh, Ladan
AU - Woods, Steven D.
AU - Coca, Steven G.
AU - Rowan, Christopher G.
N1 - Publisher Copyright:
© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2021
Y1 - 2021
N2 - Aims: This study aimed to estimate the association of patiromer exposure vs. no potassium (K+) binder (NoKb) exposure with healthcare utilization and expenditures among a cohort of Medicare Advantage patients with hyperkalemia (HK). Methods: Using Optum’s Clinformatics Data Mart (study period 2016–2019), the authors assessed propensity score-matched patients (1:1) with a serum K+ concentration ≥5.0 mmol/L and an HK diagnosis that were exposed to patiromer or NoKb on baseline characteristics. The following outcomes were compared: (1) inpatient/emergency department (ED) encounters, (2) inpatient costs greater than or equal to mean Medicare Advantage inpatient cost (i.e. $14,900), and (3) the relative healthcare spending rate. Logistic regression and zero-inflated negative binomial regression were used to analyze the outcomes. Results: The study cohort included 1,539 patiromer and NoKb matched pairs. Baseline characteristics were (patiromer/NoKb): age 74/75 years; female 42/40%; serum K+ 5.6/5.6 mmol/L; eGFR rate 36/36 mL/min/1.73 m2; low-income subsidy 42/41%, chronic kidney disease 96/96%; end-stage renal disease 12/12%; and congestive heart failure 37/36%. A total of 253 matched pairs (506 patients) remained uncensored and were analyzed at 6 months. Inpatient/ED encounters were observed for 25% (patiromer) and 37% (NoKb) (odds ratio [OR] 0.58, 95% confidence interval [CI]: 0.38–0.89). The relative odds of having inpatient costs ≥$14,900 were ∼50% less for patients exposed to patiromer vs. NoKb (OR [95% CI]: 0.47 [0.25–0.89]). The relative total healthcare spending rate (including inpatient, outpatient, ED, and pharmacy costs) was 19% less for patients exposed to patiromer vs. NoKb (spending rate ratio [95% CI]: 0.81 [0.67–0.98]). Conclusion and limitations: Among Medicare Advantage patients with HK, patiromer exposure (vs. NoKb) was associated with statistically significant reductions in the proportion with inpatient/ED encounters, inpatient costs ≥$14,900, and lower total healthcare spending. Further research, with larger sample size, is warranted to fully validate these findings.
AB - Aims: This study aimed to estimate the association of patiromer exposure vs. no potassium (K+) binder (NoKb) exposure with healthcare utilization and expenditures among a cohort of Medicare Advantage patients with hyperkalemia (HK). Methods: Using Optum’s Clinformatics Data Mart (study period 2016–2019), the authors assessed propensity score-matched patients (1:1) with a serum K+ concentration ≥5.0 mmol/L and an HK diagnosis that were exposed to patiromer or NoKb on baseline characteristics. The following outcomes were compared: (1) inpatient/emergency department (ED) encounters, (2) inpatient costs greater than or equal to mean Medicare Advantage inpatient cost (i.e. $14,900), and (3) the relative healthcare spending rate. Logistic regression and zero-inflated negative binomial regression were used to analyze the outcomes. Results: The study cohort included 1,539 patiromer and NoKb matched pairs. Baseline characteristics were (patiromer/NoKb): age 74/75 years; female 42/40%; serum K+ 5.6/5.6 mmol/L; eGFR rate 36/36 mL/min/1.73 m2; low-income subsidy 42/41%, chronic kidney disease 96/96%; end-stage renal disease 12/12%; and congestive heart failure 37/36%. A total of 253 matched pairs (506 patients) remained uncensored and were analyzed at 6 months. Inpatient/ED encounters were observed for 25% (patiromer) and 37% (NoKb) (odds ratio [OR] 0.58, 95% confidence interval [CI]: 0.38–0.89). The relative odds of having inpatient costs ≥$14,900 were ∼50% less for patients exposed to patiromer vs. NoKb (OR [95% CI]: 0.47 [0.25–0.89]). The relative total healthcare spending rate (including inpatient, outpatient, ED, and pharmacy costs) was 19% less for patients exposed to patiromer vs. NoKb (spending rate ratio [95% CI]: 0.81 [0.67–0.98]). Conclusion and limitations: Among Medicare Advantage patients with HK, patiromer exposure (vs. NoKb) was associated with statistically significant reductions in the proportion with inpatient/ED encounters, inpatient costs ≥$14,900, and lower total healthcare spending. Further research, with larger sample size, is warranted to fully validate these findings.
KW - Hyperkalemia
KW - administrative claims data
KW - chronic kidney disease
KW - end-stage renal disease
KW - healthcare resource utilization
KW - hospitalization costs
KW - patiromer
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U2 - 10.1080/13696998.2021.1965389
DO - 10.1080/13696998.2021.1965389
M3 - Article
C2 - 34357841
AN - SCOPUS:85113593968
SN - 1369-6998
VL - 24
SP - 1025
EP - 1036
JO - Journal of Medical Economics
JF - Journal of Medical Economics
IS - 1
ER -