Stroupe K T, Forthofer M M, Brater D C, Murray M D
Department of Veterans Affairs, Hines, Illinois, USA.
Pharmacoeconomics. 2000 May;17(5):429-40. doi: 10.2165/00019053-200017050-00002.
To compare the direct healthcare costs of patients with congestive heart failure (CHF) prescribed torasemide (torsemide) or furosemide (frusemide).
As part of a prospective, randomised, nonblind study, we assessed the effects of torasemide and furosemide on readmission to hospital in 193 patients treated for CHF at a US urban public healthcare system. We also calculated total direct healthcare costs for the 2 drugs. The perspective of the analysis was that of the healthcare system. Healthcare charge and utilisation data, demographic information, and health status data were obtained from an electronic database containing data for all patients treated within the healthcare system.
Upon admission to the hospital, patients were eligible if they had evidence of left ventricular systolic dysfunction, were at least 18 years old, and were receiving furosemide.
Inpatients were randomised to either torasemide or furosemide treatment for 1 year.
Patients treated with torasemide had fewer hospital admissions than those treated with furosemide [18 vs 34% for CHF (p = 0.013) and 38 vs 58% for any cardiovascular cause (p = 0.005)]. In the torasemide group, expected annual hospital costs per patient were lower for CHF admissions (by $US1054; 1998 values) and for all cardiovascular admissions (by $US1545) than in the furosemide group. Because the annual acquisition cost of torasemide was $US518 per patient higher than that of furosemide, the resulting net cost saving per patient was $US536 for CHF and $US1027 for all cardiovascular causes. Outpatient costs did not differ between treatment groups regardless of whether drug costs were considered. Total direct costs were $US2124 lower with torasemide than with furosemide (not statistically significant).
Owing largely to reduced readmission to the hospital, the cost of inpatient care for patients with CHF is significantly lower with torasemide than with furosemide, despite the higher acquisition cost of torasemide. Treatment with torasemide resulted in a nonsignificant reduction in total direct costs (outpatient plus inpatient) compared with furosemide.
比较使用托拉塞米或呋塞米治疗的充血性心力衰竭（CHF）患者的直接医疗费用。
作为一项前瞻性、随机、非盲研究的一部分，我们评估了托拉塞米和呋塞米对美国城市公共医疗系统中193例CHF治疗患者再次入院的影响。我们还计算了这两种药物的总直接医疗费用。分析的视角是医疗系统。医疗费用和使用数据、人口统计学信息以及健康状况数据均来自一个电子数据库，该数据库包含了医疗系统内所有接受治疗患者的数据。
入院时，患者若有左心室收缩功能障碍的证据、年龄至少18岁且正在接受呋塞米治疗，则符合入选标准。
住院患者被随机分配接受托拉塞米或呋塞米治疗1年。
接受托拉塞米治疗的患者比接受呋塞米治疗的患者再次入院次数更少[CHF患者再次入院率分别为18%和34%（p = 0.013），任何心血管病因导致的再次入院率分别为38%和58%（p = 0.005）]。在托拉塞米组，CHF入院患者和所有心血管疾病入院患者的预期年住院费用均低于呋塞米组（分别低1054美元；1998年价值）和1545美元。由于托拉塞米的年购置成本比呋塞米高518美元/患者，因此CHF患者每位节省的净成本为536美元，所有心血管病因导致的患者每位节省的净成本为1027美元。无论是否考虑药物成本，各治疗组的门诊费用均无差异。托拉塞米组的总直接成本比呋塞米组低2124美元（无统计学意义）。
尽管托拉塞米的购置成本较高，但主要由于再入院率降低，CHF患者使用托拉塞米的住院护理成本显著低于使用呋塞米。与呋塞米相比，托拉塞米治疗使总直接成本（门诊加住院）有非显著性降低。
