(UroToday.com) During the 2024 American Urological Association conference in San Antonio, a recent study highlights the financial burden of nephrolithiasis, commonly known as kidney stones, on the U.S. healthcare system. Potassium citrate is often prescribed for kidney stones as its effect reduces kidney stone formation, but its high cost is a significant issue for patients. The study by medical student Jake Drobner and his team at Rutgers examined how urologists' prescribing habits have changed over time, particularly regarding various alkalinizing agents.
The study analyzed urologists' prescription patterns for alkalinizing agents using data from the Medicare Part D Prescribers Database from 2013 to 2020 (Table 1). The research focused on the use of potassium citrate, potassium bicarbonate, sodium citrate, and sodium bicarbonate for managing kidney stones. Researchers calculated and examined the total annual spending, number of claims, and cost per claim for these agents over the years. This approach allowed them to track trends in prescribing habits and assess potential cost savings from shifting away from potassium citrate to other, less expensive alternatives.
The findings show that urologists predominantly prescribe potassium citrate, which accounts for over 99% of claims and costs each year. From 2013 to 2020, spending on potassium citrate nearly doubled, rising from approximately $13.7 million to $27.2 million. The cost per claim for potassium citrate was significantly higher than other alternatives such as potassium bicarbonate, sodium citrate, and sodium bicarbonate (Figure 1).
At the end of his presentation, Jake took questions about his study, particularly focusing on his data tables, which showed a decrease in the cost of potassium citrate from 2018 to 2022. When asked about the reason for this decrease, Jake suggested it could be due to increased awareness of the issue across the country and the availability of cheaper alternatives, including over-the-counter supplements. He also mentioned CostPlus, a new company founded by Mark Cuban, that offers potassium citrate for as low as $28 for a 30-day supply. An audience member pointed out that while cost is important, it's crucial to also consider what is most palatable for patients to ensure they adhere to their treatment. This valid point from the audience member underscores the need to prescribe cost-effective options that patients find acceptable, thereby improving treatment compliance.
The main takeaway from this presentation from Jake and his team is that switching from potassium citrate to more affordable alternatives could save between $11.6 million and $23.6 million each year. The study urges urologists to consider other options to lessen the financial burden on patients and improve access to kidney stone treatments. This raises an important concern about the high cost of medications meant to treat patients with kidney stones, suggesting the need for similar cost evaluations across all areas of medicine.
Table 1 Highlights the cost of potassium citrate per year over the last 8 years as well as for alternative supplements
Presented by: Jake Drobner MD/MBA Candidate, Rutgers University, New Brunswick, NJ
Coauthors: Kevin J. Chua, MD, Benjamin Lichtbroun, MD, John Pfail, Ji Hae Park, MD, New Brunswick, NJ
Written by: Paul Piedras, B.S., University of California, Irvine, @piedras_paul on Twitter during the 2024 American Urological Association (AUA) Annual Meeting, May 3-6, 2024, San Antonio, Texas