title: Evaluation of costs associated with tolvaptan-mediated length-of-stay reduction among heart failure patients with hyponatremia in the US, based on the EVEREST trial.
abstract: BACKGROUND
  The Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial showed that tolvaptan use improved heart failure (HF) signs and symptoms without serious adverse events.
  
  
  OBJECTIVE
  To evaluate the potential cost savings associated with tolvaptan usage among hospitalized hyponatremic HF patients.
  
  
  METHODS
  The Healthcare Cost and Utilization Project (HCUP) 2008 Nationwide Inpatient Sample (NIS) database was used to estimate hospital cost and length of stay (LOS), for diagnosis-related group (DRG) hospitalizations of adult (age ≥18 years) HF patients with complications and comorbidities or major complications and comorbidities. EVEREST trial data for patients with hyponatremia were used to estimate tolvaptan-associated LOS reductions. A cost offset model was constructed to evaluate the impact of tolvaptan on hospital cost and LOS, with univariate and multivariate Monte Carlo sensitivity analyses.
  
  
  RESULTS
  Tolvaptan use among hyponatremic EVEREST trial HF patients was associated with shorter hospital LOS than placebo patients (9.72 vs 11.44 days, respectively); 688,336 hospitalizations for HF DRGs were identified from the HCUP NIS database, with a mean LOS of 5.4 days and mean total hospital costs of $8415. Using an inpatient tolvaptan treatment duration of 4 days with a wholesale acquisition cost of $250 per day, the cost offset model estimated a LOS reduction among HF hospitalizations of 0.81 days and an estimated total cost saving of $265 per admission. Univariate and multivariate sensitivity analysis demonstrated that cost reduction associated with tolvaptan usage is consistent among variations of model variables.
  
  
  CONCLUSIONS
  The estimated LOS reduction and cost savings projected by the cost offset model suggest a clinical and economic benefit to tolvaptan use in hyponatremic HF patients.
  
  
  CONCLUSIONS
  The EVEREST trial data may not generalize well to the US population. Clinical trial patient profiles and relative LOS reductions may not be applicable to real-world patient populations.
authors: Loma Linda University, Loma Linda, CA, USA. junrchiong@hotmail.com
authors: Jun R
authors: JR
authors: Chiong
authors: Sonnie
authors: S
authors: Kim
authors: Jay
authors: J
authors: Lin
authors: Rudell
authors: R
authors: Christian
authors: Joseph F
authors: JF
authors: Dasta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001552:Benzazepines / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D015897:Comorbidity; D003365:Costs and Cost Analysis; D016208:Databases, Factual; D006333:Heart Failure / Q000188:drug therapy*; D017721:Hospital Costs; D006801:Humans; D007010:Hyponatremia; D007902:Length of Stay / Q000191:economics*; D008875:Middle Aged; D009010:Monte Carlo Method; D017063:Outcome Assessment, Health Care; D000077602:Tolvaptan; D014481:United States; D055815:Young Adult
chemical_list: D001552:Benzazepines; D000077602:Tolvaptan