Long-term tolvaptan cost-effective only in CHF patients needing high-dose furosemide

While tolvaptan (TLV) does not seem to provide a clear economic benefit in all patients with chronic heart failure (CHF), its use in those who require high-dose furosemide may be cost-effective, a recent study has found.

The researchers constructed a Markov model to compare a long-term TLV strategy vs the standard furosemide regimen for CHF. Parameters for comparison included total costs, quality-adjusted life years (QALYs), and an incremental cost-effectiveness ratio (ICER).

The model was conducted with a target population of 75-year-old CHF patients with a 10-year horizon. Data regarding TLV effectiveness were obtained through a meta-analysis of nine studies (n=1,010 Japanese patients, aged 55–80 years).

Modelling analysis showed that the total cost of long-term TLV was more than twice as much as that of the standard furosemide-based strategy. However, the TLV approach yielded a slightly lower QALY than furosemide (4.52 vs 4.59). Overall, the model judged TLV to have no clear clinical or economic benefit over furosemide in CHF patients.

In the scenario analysis, long-term TLV provided a higher QALY than furosemide in patients who needed high doses of furosemide (5.10 vs 4.41) but was still nearly three times as expensive than the standard strategy. Nevertheless, in this scenario, the ICER of the TLV strategy remained lower than the willingness-to-pay threshold, suggesting potential cost-effectiveness in this subpopulation of CHF patients.