P4790Burden of disease, healthcare utilization and costs of hyperkalemia: a real-world analysis of a large Italian database

Abstract

Background: There is no consensus on the prevalence of hyperkalemia in clinical practice: published studies reported estimations ranging from 1.1% to 10% of all hospital admissions or consultations. This condition could have life-threatening consequences and needs to be recognized as early as possible. This study has the aim to assess the burden of hyperkalemia in a real world setting and to provide healthcare utilization and costs for the National Health Service (NHS). Methods: From the ARCO database (a network of regional and local health administrative data sources), Italian adult (≥18 years) inhabitants with at least one hospitalization for “hyperkalemia” (ICD9 CM: 276.7) and/or a prescription of polystyrene sulfonate (ATC: V03AE01) were selected over 2014. Both comorbidities and drugs known to be generally associated with hyperkalemia were identified in the previous year. The 1-year follow-up was evaluated to describe healthcare utilization and costs for the NHS, in terms of reimbursed drug prescriptions, hospitalizations and outpatient visits. Results: Out of 12,533,230 inhabitants, 3,732 adult patients (35.4 x100,000) experienced hyperkalemia in the year 2014. Mean age (±SD) of patients with hyperkalemia was 73±14, female sex accounted for 39% of the total study population. Chronic renal failure was reported in 58.9% of patients with hyperkalemia, diabetes in 39.7% and chronic heart failure in 11.3%. Moreover, 85.5% subjects received, in the previous year, drugs potentially associated with hyperkalemia: ACE-inhibitors (39.7%), Angiotensin II antagonists (35.2%), mineralcorticoid antagonists (14.9%). Over the 1-year follow-up, 83.3% patients were treated with polystyrene sulfonate, 56.7% were admitted to hospital at least once. In the perspective of the NHS, the average annual cost per patient was 15,686-, with outpatient services (mainly dialysis) the main cost driver. Conclusions: Patients who experienced hyperkalemia showed several comorbidities and determinated a very high cost were very expensive for the NHS. This analysis of the ARCO database provides a real-word picture of this potentially life threatening clinical condition, useful to estimate the possible dimension of the target population of the incoming innovative therapies.