{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,17]],"date-time":"2025-12-17T13:05:55Z","timestamp":1765976755684,"version":"3.40.5"},"reference-count":49,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T00:00:00Z","timestamp":1709596800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nephrology"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Hyperkalaemia (HK) is prevalent among patients with chronic kidney disease (CKD) and chronic heart failure, especially if they are treated with renin\u2010angiotensin\u2010aldosterone system inhibitors (RAASi). This study evaluated the cost\u2010effectiveness of a newly developed anti\u2010HK therapy, sodium zirconium cyclosilicate (SZC), to the current standard of care for treating HK in advanced CKD patients from the Singapore health system perspective.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We adapted a global microsimulation model to simulate individual patients' potassium level trajectories with baseline potassium \u22655.5\u2009mmol\/L, CKD progression, changes in treatment, and other fatal and non\u2010fatal events. Effectiveness data was derived from ZS\u2010004 and ZS\u2010005 trials. Model parameters were localised using CKD patients' administrative and medical records at the Singapore General Hospital Department of Renal Medicine. We estimated the lifetime cost and quality\u2010adjusted life years (QALYs) of each HK treatment, and the incremental cost\u2010effectiveness ratio of SZC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>SZC demonstrated cost\u2010effectiveness with an incremental cost\u2010effectiveness ratsio of SGD 45\u2009068 per QALY over a lifetime horizon, below the willingness\u2010to\u2010pay threshold of SGD 90\u2009000 per QALY. Notably, SZC proved most cost\u2010effective for patients with less severe CKD who were concurrently using RAASi. Sensitivity analyses confirmed the robustness of the findings, accounting for alternative parameter values and statistical uncertainty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study establishes the cost\u2010effectiveness of SZC as a treatment for HK, highlighting its potential to mitigate the risk of hyperkalaemia and optimise RAASi therapy. These findings emphasise the value of integrating SZC into the Singapore health system for improved patient outcomes and resource allocation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nep.14284","type":"journal-article","created":{"date-parts":[[2024,3,6]],"date-time":"2024-03-06T04:04:20Z","timestamp":1709697860000},"page":"278-287","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["<scp>Cost\u2010effectiveness<\/scp> of sodium zirconium cyclosilicate for advanced chronic kidney patients in Singapore"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3291-4523","authenticated-orcid":false,"given":"Junxing","family":"Chay","sequence":"first","affiliation":[{"name":"Health Services and Systems Research Duke\u2010NUS Medical School  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8477-0875","authenticated-orcid":false,"given":"Jason C. J.","family":"Choo","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine Singapore General Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6443-9686","authenticated-orcid":false,"given":"Eric A.","family":"Finkelstein","sequence":"additional","affiliation":[{"name":"Health Services and Systems Research Duke\u2010NUS Medical School  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,3,5]]},"reference":[{"doi-asserted-by":"publisher","key":"e_1_2_8_2_1","DOI":"10.1038\/nrneph.2014.168"},{"doi-asserted-by":"publisher","key":"e_1_2_8_3_1","DOI":"10.1016\/j.jjcc.2010.09.004"},{"doi-asserted-by":"publisher","key":"e_1_2_8_4_1","DOI":"10.1186\/cc11872"},{"doi-asserted-by":"publisher","key":"e_1_2_8_5_1","DOI":"10.1093\/eurheartj\/suy028"},{"doi-asserted-by":"publisher","key":"e_1_2_8_6_1","DOI":"10.1016\/j.jacc.2013.10.050"},{"doi-asserted-by":"publisher","key":"e_1_2_8_7_1","DOI":"10.2147\/CE.S129555"},{"doi-asserted-by":"publisher","key":"e_1_2_8_8_1","DOI":"10.1111\/acem.13954"},{"doi-asserted-by":"publisher","key":"e_1_2_8_9_1","DOI":"10.1056\/NEJMoa1411487"},{"doi-asserted-by":"publisher","key":"e_1_2_8_10_1","DOI":"10.1001\/jama.2014.15688"},{"doi-asserted-by":"publisher","key":"e_1_2_8_11_1","DOI":"10.1159\/000504078"},{"doi-asserted-by":"publisher","key":"e_1_2_8_12_1","DOI":"10.1681\/asn.2019050450"},{"doi-asserted-by":"publisher","key":"e_1_2_8_13_1","DOI":"10.2215\/cjn.12651018"},{"doi-asserted-by":"publisher","key":"e_1_2_8_14_1","DOI":"10.1016\/j.mayocp.2020.06.014"},{"doi-asserted-by":"publisher","key":"e_1_2_8_15_1","DOI":"10.1007\/s40273\u2010020\u201000902\u2010w"},{"doi-asserted-by":"publisher","key":"e_1_2_8_16_1","DOI":"10.1016\/j.jval.2017.08.519"},{"doi-asserted-by":"publisher","key":"e_1_2_8_17_1","DOI":"10.1080\/13696998.2022.2074193"},{"doi-asserted-by":"publisher","key":"e_1_2_8_18_1","DOI":"10.1007\/s41669\u2010022\u201000357\u2010z"},{"doi-asserted-by":"publisher","key":"e_1_2_8_19_1","DOI":"10.1186\/s12882\u2010022\u201002903\u20107"},{"doi-asserted-by":"publisher","key":"e_1_2_8_20_1","DOI":"10.1080\/13696998.2018.1518239"},{"doi-asserted-by":"publisher","key":"e_1_2_8_21_1","DOI":"10.1186\/s12882\u2010019\u20101228\u2010y"},{"unstructured":"ZS Pharma I.Open\u2010label safety & efficacy of ZS (sodium zirconium cyclosilicate)10g qd to extend study ZS\u2010004 in hyperkalemia.https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02107092","key":"e_1_2_8_22_1"},{"unstructured":"ZS Pharma I.Open\u2010label safety and efficacy of sodium zirconium cyclosilicate for up to 12 Months.https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02163499","key":"e_1_2_8_23_1"},{"unstructured":"ZS Pharma I.Safety & efficacy of zirconium silicate dosed for 28\u2009days in hyperkalemia. Accessed 18 November 2016 https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02088073","key":"e_1_2_8_24_1"},{"doi-asserted-by":"publisher","key":"e_1_2_8_25_1","DOI":"10.7326\/0003\u20104819\u2010158\u201011\u2010201306040\u201000007"},{"unstructured":"ZS Pharma I.Clinical study report: ZS\u2010005. A phase 3 multicenter multi\u2010dose open\u2010label maintenance study to investigate the long\u2010term safety and efficacy of ZS (sodium zirconium cycosilicate) an oral sorbent in subjects with hyperkalemia [CONFIDENTIAL internal manufacturer's report].2017.","key":"e_1_2_8_26_1"},{"doi-asserted-by":"publisher","key":"e_1_2_8_27_1","DOI":"10.1093\/ndt\/gfr696"},{"doi-asserted-by":"publisher","key":"e_1_2_8_28_1","DOI":"10.1007\/s40266\u2010020\u201000824\u20104"},{"doi-asserted-by":"publisher","key":"e_1_2_8_29_1","DOI":"10.3233\/JRS\u2010200096"},{"volume-title":"Drug Evaluation Methods and Process Guide","year":"2018","author":"Agency for Care Effectiveness (ACE)","key":"e_1_2_8_30_1"},{"doi-asserted-by":"publisher","key":"e_1_2_8_31_1","DOI":"10.2471\/blt.15.164418"},{"doi-asserted-by":"publisher","key":"e_1_2_8_32_1","DOI":"10.1371\/journal.pone.0186496"},{"doi-asserted-by":"publisher","key":"e_1_2_8_33_1","DOI":"10.1093\/heapol\/czw096"},{"doi-asserted-by":"publisher","key":"e_1_2_8_34_1","DOI":"10.2165\/11599390\u2010000000000\u201000000"},{"unstructured":"Pharmacoeconomic Review Report: Sodium Zirconium Cyclosilicate (Lokelma): (AstraZeneca Canada Inc.): Indication: For the treatment of hyperkalemia in adult patients. Canadian Agency for Drugs and Technologies in Health.https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK563723\/","key":"e_1_2_8_35_1"},{"doi-asserted-by":"publisher","key":"e_1_2_8_36_1","DOI":"10.1002\/phar.1906"},{"doi-asserted-by":"publisher","key":"e_1_2_8_37_1","DOI":"10.1161\/jaha.116.005428"},{"doi-asserted-by":"publisher","key":"e_1_2_8_38_1","DOI":"10.1093\/ehjcvp\/pvy015"},{"issue":"4","key":"e_1_2_8_39_1","first-page":"455","article-title":"Treatment of hyperkalemia in patients with chronic kidney disease: a comparison of calcium polystyrene sulphonate and sodium polystyrene sulphonate","volume":"26","author":"Nasir K","year":"2014","journal-title":"J Ayub Med Coll Abbottabad"},{"unstructured":"Haymarket Media Group Ltd.Monthly Index of Medical Specialities.http:\/\/www.mims.co.uk\/","key":"e_1_2_8_40_1"},{"unstructured":"Ministry of Health (Singapore).Historical transacted bill sizes and fee benchmarks.https:\/\/www\u2010moh\u2010gov\u2010sg\u2010admin.cwp.sg\/docs\/librariesprovider5\/excel\u2010uploads\/fee\u2010publication\u2010data\u2010july19\u2010dec20\u2010(for\u2010download1).xlsx?sfvrsn=b69dffe7_2","key":"e_1_2_8_41_1"},{"doi-asserted-by":"publisher","key":"e_1_2_8_42_1","DOI":"10.1111\/nep.13478"},{"unstructured":"Department of Health.NHS reference costs 2014 to 2015.https:\/\/www.gov.uk\/government\/publications\/nhs-reference-costs-2014-to-2015","key":"e_1_2_8_43_1"},{"unstructured":"National Registry of Diseases Office.Singapore Renal Registry Annual Report 2018.https:\/\/www.nrdo.gov.sg\/docs\/librariesprovider3\/default-document-library\/singapore-renal-registry-annual-report-2018.pdf","key":"e_1_2_8_44_1"},{"doi-asserted-by":"publisher","key":"e_1_2_8_45_1","DOI":"10.34067\/kid.0004382020"},{"unstructured":"National Institute for Health and Care Excellence.Clinical guideline [CG125]: Chronic kidney disease (stage 5): peritoneal dialysis.https:\/\/www.nice.org.uk\/guidance\/cg125","key":"e_1_2_8_46_1"},{"doi-asserted-by":"publisher","key":"e_1_2_8_47_1","DOI":"10.1007\/s11136\u2010014\u20100859\u20105"},{"doi-asserted-by":"publisher","key":"e_1_2_8_48_1","DOI":"10.1185\/030079905X65277"},{"unstructured":"Singapore Department of Statistics.Complete life tables for Singapore resident population 2018\u20132019.https:\/\/www.singstat.gov.sg\/-\/media\/files\/publications\/population\/lifetable18-19.pdf","key":"e_1_2_8_49_1"},{"doi-asserted-by":"publisher","key":"e_1_2_8_50_1","DOI":"10.1016\/j.ekir.2021.08.027"}],"container-title":["Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nep.14284","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,12]],"date-time":"2024-04-12T06:39:31Z","timestamp":1712903971000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nep.14284"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,5]]},"references-count":49,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1111\/nep.14284"],"URL":"https:\/\/doi.org\/10.1111\/nep.14284","archive":["Portico"],"relation":{},"ISSN":["1320-5358","1440-1797"],"issn-type":[{"type":"print","value":"1320-5358"},{"type":"electronic","value":"1440-1797"}],"subject":[],"published":{"date-parts":[[2024,3,5]]},"assertion":[{"value":"2023-07-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-05","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}