The value of maintaining normokalaemia and enabling RAASi therapy in chronic kidney disease

Fig. 1. Flow diagram summarising CKD health states (shaded) and events (unshaded) applied in the model. Disease progression and the incidence of modelled events may be modified according to serum potassium level (grey circles), RAASi usage (white triangles) and/or CKD stage (black squares). CKD: chronic kidney disease; RAASi: renin-angiotensin-aldosterone system inhibitor

Fig. 2. Comparison of predicted IRRs for death and MACE, as a function of serum potassium level, against IRRs from other studies. Grey lines indicate IRRs from observational studies; black lines indicate predicted IRRs. IRRs reported by Luo et al. were adjusted for selected patient attributes. CPRD Clinical Practice Research Datalink, IRR incidence rate ratio, MACE major adverse cardiovascular event

Fig. 3. Discounted cost breakdown for modelled CKD patients receiving optimal serum potassium management to enable ongoing RAASi therapy (treatment arm), compared against patients not receiving RAASi to maintain normokalaemia (control arm). CKD chronic kidney disease, CV cardiovascular event, RAASi renin-angiotensin-aldosterone system inhibitor, RRT renal replacement therapy

Fig. 4. Impact of model inputs on incremental discounted costs, QALYs and NMB (WTP at £20,000 per QALY gained). CKD chronic kidney disease, CV cardiovascular event, NMB net monetary benefit, QALY quality-adjusted life-year, RAASi renin-angiotensin-aldosterone system inhibitor, RRT renal replacement therapy, WTP willingness-to-pay threshold

Fig. 5. Evolution of mean health state utility, undiscounted health state costs and associated absolute NMB (WTP at £20,000 per QALY gained) over 20 years in surviving CKD patients. CKD chronic kidney disease, ESRD end stage renal disease, NMB net monetary benefit, QALY quality-adjusted life-year, RRT renal replacement therapy, WTP willingness-to-pay threshold