Tolvaptan Reduces Long-Term Total Medical Expenses and Length of Stay in Aquaporin-Defined Responders

Abstract

SummaryThe vasopressin type-2 antagonist tolvaptan (TLV) has clinical advantages including amelioration of congestion and normalization of hyponatremia in patients with decompensated heart failure (HF). However, there have been no studies on the cost-effectiveness of TLV therapy. We enrolled 60 consecutive hospitalized patients with stage D HF who received TLV [TLV (+) group], and 60 propensity score-matched HF patients without TLV treatment [TLV (-) group]. We excluded 54 patients who died or received cardiac replacement therapy within 1 year, and finally enrolled 32 patients who received TLV and 34 who did not, who were followed for > 1 year. Among 45 aquaporin-defined responders, whose urine aquaporin-2 relative to plasma arginine vasopressin level was > 1.4 × 10 3 L/g Cre, the TLV (+) group required significantly lower total medical expenses and shorter lengths of stay (LOS) In contrast, among the remaining 21 aquaporin-defined non-responders, medical expenses and LOS were comparable irrespective of TLV administration (P = 0.087 and P = 0.407). In conclusion, TLV therapy may reduce total medical expenses in aquaporin-defined responders with stage D HF. (Int Heart J 2016; 57: 593-599)

Update of acute and long-term tolvaptan therapy

“…3) [27]. As a result, tolvaptan therapy reduced the total medical expense in the responders but not in the non-responders [29]. A prospective study of long-term tolvaptan therapy in predicted responders is ongoing [30].…”

Effect of tolvaptan on the prognosis of patients with hepatic ascites

“…The propensity score was estimated using a multivariate logistic regression analysis including tolvaptan therapy as the dependent variable, and the following 15 explanatory variables as covariates: Child-Pugh classification, HCC and its stage at the start of the observation period, background liver status, presence or absence of diabetes, total bilirubin level, alanine aminotransferase level, red blood cell count, platelet count, prothrombin time (%), and Creactive protein level, in addition to the variables used in previous studies, 4,25 including age, sex, serum sodium concentration, and serum creatinine concentration. Then, oneto-one matching with a 0.01 caliper was carried out to create matched patient pairs.…”

Cost-Effectiveness Analysis of Cardiovascular Disease Treatment in Japan

“…A Japanese study showed tolvaptan reduced the cost of treatment for heart failure in aquaporin-defined responders. 33) Compared with conventional therapy, tolvaptan showed lower medical cost (1,120,000 yen/year versus 3,120,000 yen/year, respectively) and shorter hospital stay (30 days versus 70 days, respectively). Tolvaptan could be cost-effective in certain types of heart failure.…”