P0321OUR EXPERIENCE OF PATIROMER (VELTASSA) USE AND POTENTIAL COST-BENEFITS AT SOUTH TYNESIDE AND SUNDERLAND NHS FT, U.K

Abstract

Abstract Background and Aims Patiromer is a new medication used to manage hyperkalaemia and acts as a bowel cation-exchange polymer with a simpler dosing and more favourable side effect profile than existing agents. In May 2018, South Tyneside and Sunderland NHS Foundation Trust (STSFT) implemented a protocol for the use of Patiromer in managing chronic hyperkalaemia to enhance options for managing cardio-renal patients in clinic. Conditional on our successful formulary application, was an audit against the protocol aiming to understand utility. Our second aim was to identify potential cost-benefits of patiromer. In particular, we were interested in preventing hospital admissions, bed days saved, temporary venous lines and dialysis sessions. It is important to note this analysis is subject to interpretation based on likely outcome should patiromer not have been given. Method To be eligible, patients had to have eGFR <30 and either a potassium >5.5 precluding the use of RAASi/MRAs or a recurrent potassium >6. Using electronic patient record system, we investigated 49 patients commenced on patiromer between October 2018 and October 2019. Results Only 14% of the incident prescriptions were in clinic with over half starting at a higher than UK licensed dose (once daily). The distribution of hyperkalaemia was varied as defining hyperkalaemia onset is challenging and what we found as more emergency use. We also identified the following clinical savings: 12 fewer bed days, 15 temporary lines and a minimum of 25 dialysis sessions avoided. Interestingly, we also found that in 2 cases, physicians utilised patiromer and avoided a referral to the renal team. Furthermore, we identified 11 uses of patiromer in the conservative/palliative setting allowing patients to withdraw from dialysis and to prevent discussions on commencing renal replacement therapy for concerns around hyperkalaemia. It would also provide a quality of life benefit avoiding recurrent cannulation to facilitate the standardised medical management of hyperkalaemia. Conclusion In conclusion, whilst this may not demonstrate an objective cost benefit, it does show the versatility of patiromer use in clinical practice. We have found an emphasis on usage in the inpatient setting to avoid dialysis and its attendant costs, rather than where its evidence base originates: as a renin-aldosterone blockade enabler in the outpatient setting. We have demonstrated awareness of adhering to the protocol criteria, whilst understanding the pitfalls of the protocol and why the medication has been administered out with of it, especially with regards to dosing. We wish to share our experience with clinicians and raise awareness of their growing armamentarium.