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

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    • Imamura Teruhiko
    • Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
    • Kinugawa Koichiro
    • Department of Second Department of Internal Medicine, Toyama University Hospital
    • Nitta Daisuke
    • Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
    • Komuro Issei
    • Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo


<p>The 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<sup>3</sup> L/g Cre, the TLV (+) group required significantly lower total medical expenses and shorter lengths of stay (LOS) compared with the TLV (-) group [11.2 (1.233.3) versus 31.2 (2.2-71.4) × 10<sup>5</sup> JPY/year, <i>P</i> < 0.001; 30 (0-304) versus 70 (20-221) days, <i>P</i> = 0.030]. In contrast, among the remaining 21 aquaporin-defined non-responders, medical expenses and LOS were comparable irrespective of TLV administration (<i>P</i> = 0.087 and <i>P</i> = 0.407). In conclusion, TLV therapy may reduce total medical expenses in aquaporin-defined responders with stage D HF.</p>


  • International Heart Journal

    International Heart Journal 57(5), 593-599, 2016

    International Heart Journal Association


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