Presented by: Benjamin Lichtbroun MD
Rutgers Robert Wood Johnson Medical School

Introduction

The rising incidence of nephrolithiasis places a hefty financial burden on the U.S. healthcare system. Potassium citrate, a mainstay in the medical management of nephrolithiasis, is cost-prohibitive for patients and further exacerbates this burden. Alternative alkalinizing agents have demonstrated similar efficacy and are less expensive. This study aims to examine urologists’ prescribing patterns for alkalinizing agents over time.

Materials

The Medicare Part D Prescribers Database was used to identify prescriptions by urologists for alkalinizing agents including potassium citrate, potassium bicarbonate, sodium citrate, and sodium bicarbonate. The total annual expenditure, number of claims, and cost per claim from 2013 to 2020 were analyzed.

Results

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Potassium citrate represented >99% of claims and costs each year for alkalinizing agents. Expenditure for potassium citrate increased from $13,711,645.99 in 2013 to $27,189.128.66 in 2020 (Table). Claims for potassium citrate also increased from 97,734 in 2013 to 152,450 in 2020. The percentage of branded potassium citrate prescribed, which was $49.49–$170.80 more expensive per claim than the generic version, declined from 2.23% in 2013 to 0.02% in 2020. The yearly cost per claim was $140.30–$209.37, $27.00–$47.35, $18.17–$42.69, and $21.75–$70.56 for potassium citrate, potassium bicarbonate, sodium citrate, and sodium bicarbonate, respectively. Potassium citrate was $118.54–$155.04 more expensive per claim than the next most expensive alternative and $122.09–$185.84 more expensive per claim than the cheapest alternative. Prescribing the next most expensive alternative instead of potassium citrate would have resulted in cost savings ranging from $11,585,492.14–$23,573,029.70 per year.

Conclusion

Urologists can generate significant cost savings by prescribing alternative alkalinizing agents. Lowering the cost of alkali therapy is essential to reducing financial toxicity for patients and improving equitable access to preventative stone treatment.

Funding

None

Co-Authors

Kevin Chua, MD
Rutgers Robert Wood Johnson Medical School

John Pfail, MD
Rutgers Robert Wood Johnson Medical School

Ji Hae Park, MD
Rutgers Robert Wood Johnson Medical School