This paper is only available as a PDF. To read, Please Download here.
Abstract
The management of patients with congestive heart failure (CHF) can place a significant
economic burden on managed care organizations, leading providers to seek treatments
that are cost-effective. Diuretics play a significant role in the treatment of edema
associated with CHF. We evaluated the use of 2 loop diuretics, torsemide and furosemide,
in patients with CHF in a managed care setting. This prospective study compared clinical,
economic, and qualityof-life outcomes in 240 patients randomized to the 2 drugs. Patients
with New York Heart Association (NYHA) class II or class III CHF requiring loop diuretic
treatment, either alone or in conjunction with other therapy, were eligible. Patients
were told about the study during an office visit, and those with an interest in participating
and who met the eligibility criteria were given further information and the opportunity
to participate. After investigators obtained informed consent, patients were enrolled,
randomized to either treatment, and followed for 6 months. Outcomes included CHF/cardiovascular
(CV)-related medical costs, change in NYHA class, change in sodium retention score,
hospitalizations, physician visits, medication use, adverse events, and change in
quality of life. A total of 103 patients were randomized to torsemide, and 137 patients
were randomized to furosemide. Except for body weight, patient demographic characteristics
did not differ between groups at baseline; patients in the torsemide group were significantly
heavier (P = 0.004). The results showed that mean total CHF/CV-related medical costs did not
differ between groups (torsemide, $1520.07; furosemide, $1503.26; P = 0.975), despite higher mean drug-acquisition costs for torsemide patients ($121.01
vs $42.95; P < 0.0001). Mean costs were similar for CHF/CV-related hospitalizations (torsemide,
$845.84; furosemide, $893.33; P = 0.918) and CHF-related physician visits (torsemide, $138.80; furosemide, $164.09;
P = 0.288). Quality of life was significantly better for patients in the torsemide
group at month 4 (P = 0.017), but not at month 2 (P = 0.059) or month 6 (P = 0.269). The number of adverse events did not differ significantly between groups
(torsemide, 221; furosemide, 287; P= 0.916). The results of this study appear to indicate that in a representative cross-section
of managed care patients, those who received torsemide, despite higher drug-acquisition
costs, had similar CHF/CV-related management costs compared with furosemide recipients.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical TherapeuticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The cost-effective way forward for the management of the patient with heart failure.Cardiology. 1994; 87: 33-39
- Cost-effectiveness in clinical cardiology, Part 1: Coronary artery disease and congestive heart failure.Chest. 1996; 109: 1359-1369
- Managed care clinical corner: A case of congestive heart failure—the managed care perspective.Am J Managed Care. 1997; 3: 303-306
- Chronic care costs in managed care.Health Aff. 1997; 16: 239-247
- Economic impact of heart failure in the United States: Time for a different approach.J Heart Lung Transplant. 1993; 13: S107-S112
- Guidelines for the evaluation and management of heart failure.Circulation. 1995; 92: 2764-2784
- The management of chronic heart failure.NEJM. 1996; 335: 490-498
- Comparison of intravenous torsemide, furosemide in moderate to severe congestive heart failure.in: Puschett JB Diuretics IV: Chemistry,Pharmacology and Clinical Applications. Elsevier, Amsterdam1993: 49-50
- Controlled, doubleblind clinical trial on the efficacy and tolerance of torsemide in comparison with furosemide in patients with congestive heart failure—a multicenter study.Prog Pharmacol Clin Pharmacol. 1990; 8: 121-126
- Bioavailability, pharmacokinetics, and pharmacodynamics of torsemide and furosemide in patients with congestive heart failure.Clin Pharmacol Ther. 1995; 57: 601-609
- Bioavailability, pharmacokinetics, and pharmacodynamics of torsemide in patients with cirrhosis.Clin Pharmacol Ther. 1993; 54: 90-97
- Second-line therapy of congestive heart failure with torsemide.Prog Pharmacol Clin Pharmacol. 1990; 8: 105-120
- Torsemide, a new potent diuretic.Eur J Clin Pharmacol. 1986; 31 (Suppl): 29-34
- Cost analysis of loop diuretics in heart failure.Congestive Heart Fail. 1995; 6: 26-31
- Pharmacoeconomic comparison of loop diuretics in the treatment of congestive heart failure.Med Interface. 1996; 1: 101-106
- A pharmacoeconomic assessment of torsemide in the treatment of congestive heart failure.Am J Managed Care. 1996; 2: 1428-1434
- The need for a sodium retention score in clinical trials of heart failure.Clin Pharmacol Ther. 1993; 54: 7-10
- Patients' self-assessment of their congestive heart failure: II. Content, reliability and validity of a new measure—the Minnesota Living with Heart Failure questionnaire.Heart Fail. 1987; 3: 198-209
- Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: Reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan.Am Heart J. 1992; 124: 1017-1025
- Validity of the Minnesota Living with Heart Failure questionnaire as a measure of therapeutic response to enalapril or placebo.Am J Cardiol. 1993; 71: 1106-1107
Article info
Publication history
Accepted:
March 12,
1999
Identification
Copyright
© 1999 Published by Elsevier Inc.
