PMID- 11456215
OWN - NLM
STAT- MEDLINE
DCOM- 20010809
LR  - 20181130
IS  - 1170-7690 (Print)
IS  - 1170-7690 (Linking)
VI  - 19
IP  - 6
DP  - 2001
TI  - Torasemide: a pharmacoeconomic review of its use in chronic heart failure.
PG  - 679-703
AB  - Torasemide is a loop diuretic used for the treatment of hypertension and for 
      oedema in chronic heart failure (CHF), renal failure and cirrhosis. The efficacy 
      of torasemide in reducing salt and water retention in CHF has been established in 
      double-blind comparative studies against furosemide. Torasemide has been shown to 
      be at least as effective as furosemide in terms of total volume of urine excreted 
      and also has a longer duration of action. The efficacy of torasemide (in terms of 
      improved CHF symptoms and reduced pulmonary congestion, oedema and bodyweight) 
      has been shown in randomised controlled trials and confirmed in large 
      postmarketing studies. In addition, data from postmarketing studies have shown 
      that patients receiving torasemide had significantly reduced hospital admission 
      rates compared with patients receiving furosemide. Pharmacoeconomic assessments 
      of torasemide have focused on its effect in reducing hospitalisation. 
      Hospitalisation costs due to CHF decreased by 86% during the 11.2-month period of 
      torasemide treatment, compared with the 6-month period prior to treatment, in a 
      US retrospective study assessing medical and pharmacy claims data. Overall, 
      average monthly costs for patients decreased by 56.6% after 5.1 months (from 
      $US1,897.28 to $US823.70 per patient per month; PPPM), and by 76% after 11.2 
      months (from $US1,944.76 to $US470.76 PPPM) of torasemide treatment. In the 
      furosemide group, average monthly costs for patients increased moderately from 
      $US227.28 to $US261.18 PPPM after 12 months. Direct comparison of the torasemide 
      and furosemide study groups was not possible because the group receiving 
      torasemide had much higher healthcare resource use at baseline. Compared with 
      furosemide, torasemide was associated with reduced rates of hospital admissions 
      for CHF and/or cardiovascular causes in 3 studies, a retrospective analysis 
      conducted in Germany, a prospective US study of patients enrolled from hospital 
      admissions and a decision-analysis model. As a result, the direct costs of 
      treatment for CHF or cardiovascular diseases for patients treated with torasemide 
      were less than those with furosemide. However, in the US study, there was no 
      statistically significant difference in hospital admissions for all causes and/or 
      in overall direct medical costs, although the study was not powered to show this. 
      In another US study of managed care patients with New York Heart Association 
      (NYHA) class II or III CHF, no difference in clinical or economic outcomes was 
      observed between patients taking torasemide or furosemide; despite the higher 
      acquisition costs for torasemide, total costs were similar for both groups. 
      Torasemide was found to be more cost effective than furosemide in terms of cost 
      per patient with improved functional (NYHA) class of CHF severity in a 
      retrospective German analysis, although this measure is not ideal. This study 
      also evaluated indirect costs (for loss of productivity of employed patients) and 
      resultssuggest torasemide has a favourable effect in reducing days off work 
      compared with furosemide, although the population of employed patients in the 
      study was very small. Torasemide has been shown to improve some measures of 
      quality of life in 2 studies. It was associated with higher quality-of-life 
      scores than furosemide in a 6-month study, but the differences were only 
      significant at month 4. In another study, torasemide significantly improved 
      fatigue, but full study details are yet to be published. CONCLUSIONS: Despite the 
      higher acquisition cost of torasemide over furosemide, pharmacoeconomic analyses 
      have shown that torasemide is likely to reduce overall treatment costs of CHF by 
      reducing hospital admissions and readmissions. Torasemide has generally shown 
      clinical and economic advantages over furosemide, although more long term data 
      are needed to confirm these results and to further investigate effects on quality 
      of life. There are limitations to the currently available pharmacoeconomic data, 
      but present data support the use of torasemide as a first-line option for 
      diuretic therapy in patients with CHF presenting with oedema and especially in 
      those patients not achieving relief of symptoms with furosemide.
FAU - Young, M
AU  - Young M
AD  - Adis International Limited, Auckland, New Zealand.
FAU - Plosker, G L
AU  - Plosker GL
LA  - eng
PT  - Journal Article
PL  - New Zealand
TA  - Pharmacoeconomics
JT  - PharmacoEconomics
JID - 9212404
RN  - 0 (Sulfonamides)
RN  - W31X2H97FB (Torsemide)
MH  - Chronic Disease
MH  - Clinical Trials as Topic
MH  - Costs and Cost Analysis
MH  - Heart Failure/*drug therapy/*economics
MH  - Humans
MH  - Sulfonamides/*economics/*therapeutic use
MH  - Torsemide
EDAT- 2001/07/18 10:00
MHDA- 2001/08/10 10:01
CRDT- 2001/07/18 10:00
PHST- 2001/07/18 10:00 [pubmed]
PHST- 2001/08/10 10:01 [medline]
PHST- 2001/07/18 10:00 [entrez]
AID - 10.2165/00019053-200119060-00006 [doi]
PST - ppublish
SO  - Pharmacoeconomics. 2001;19(6):679-703. doi: 10.2165/00019053-200119060-00006.