Utilization and budget impact of tolvaptan in the inpatient setting among patients with heart failure and hyponatremia

Abstract

Objective: Assess characteristics of patients with heart failure (HF) and hyponatremia (HN) using tolvaptan, a selective vasopressin V2-receptor antagonist, for sodium correction, and estimate the budget impact of tolvaptan use in a hospital.

Methods: The Premier hospital database was analyzed to assess the utilization of tolvaptan, characteristics of users and non-users, and hospitalization costs among patients with HF and HN. Using these findings, a model was developed to estimate tolvaptan costs in proportion to total medical costs of managing patients with HF and HN, and the budget impact of tolvaptan use. Results were regenerated using data from the Healthcare Cost and Utilization Project (HCUP) database, and robustness was assessed in sensitivity analyses.

Results: Tolvaptan was used in 4.96% of inpatient visits among patients with HF and HN, more commonly among sicker patients as reflected in high utilization during intensive care stays (30.46%). Additionally, utilization increased by length of stay, which can serve as a proxy for disease severity. The model estimated that tolvaptan costs accounted for 0.3% of total hospitalization-related costs for patients with HF and HN, and the budget impact was $52.42 per visit.

Conclusions: Results demonstrate that tolvaptan is used infrequently among patients with HF and HN, and is utilized among sicker patients. Tolvaptan accounted for 0.3% of total spending on management of inpatient visits with HF and HN, and had a marginal impact on hospital budget when compared with fluid restriction for HN correction. Availability of tolvaptan can provide an additional therapeutic option for sodium correction.

Keywords:

• Heart failure
• hyponatremia
• budget impact
• sodium
• hospitalization
• economic model
• tolvaptan

Transparency

Declaration of funding

This study was funded by Otsuka Pharmaceutical Development & Commercialization Inc.

Author contributions: S.A.K., S.L.C. and S.V.S. were involved in the conception and design. J.D.O., R.A.S. and A.L.H. were involved in data collection. A.N.A., J.D.O. and A.L.H. were involved in analysis and interpretation of that data. J.D.O. and A.L.H. drafted the paper. A.N.A., S.L.C. and S.V.S. revised it critically for intellectual content. All authors gave final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

Declaration of financial/other relationships

R.A.S., S.L.C. and S.V.S. have disclosed that they are employees of Otsuka Pharmaceutical Development & Commercialization Inc., who manufacture tolvaptan. At the time of preparation and submission of this manuscript, S.A.K. was an employee of Otsuka Pharmaceutical Development & Commercialization Inc., who manufacture tolvaptan. J.D.O. and A.L.H. have disclosed that they are employees of PHAR LLC, which was paid as a consultant to conduct the research described in this manuscript. A.N.A. has disclosed that he was paid as a consultant to conduct the research described in this manuscript.

A reviewer on this paper is a consultant to Otsuka in hyponatremia; however, was not involved with this study. All other CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.