Long-term tolvaptan not cost-effective against chronic heart failure

Tolvaptan does not seem to be a cost-effective option for long-term treatment of chronic heart failure (CHF), reports a recent Japan study.

The researchers constructed a Markov model to evaluate the total cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) of long-term tolvaptan as compared against the standard strategy of furosemide. The model was applied to a target population of 75-year-old CHF patients over a 10-year horizon.

In the base case analysis, the standard strategy demonstrated a long-term total cost of JPY 1,179,964, nearly three times lower than the cumulative costs of using tolvaptan (JPY 3,243,779). In turn, total QALYs were better with furosemide vs tolvaptan (4.59 vs 4.52). According to the researchers, “these results indicated that the long-term tolvaptan strategy was dominated by the standard strategy.”

Cost-effectiveness acceptability curves further showed that across all willingness-to-pay (WTP) thresholds, the standard strategy outperformed tolvaptan. For instance, at a WTP of JPY 5,000,000, tolvaptan only had a 9.6 percent chance of being cost-effective.

The researchers then performed subsequent scenario analyses and found that while long-term tolvaptan was more effective than furosemide (total QALYs 5.10 vs 4.41), total costs were much higher. However, the ICER of long-term tolvaptan vs furosemide was below a WTP threshold of JPY 5,000,000, suggesting that in patients who require prolonged treatment of high-dose furosemide, tolvaptan may be a cost-effective alternative.