Clinical and economic factors in the selection of low-osmolality contrast media

Both high- and low-osmolality contrast media are available for most radiographic procedures requiring iodinated contrast material. Newer low-osmolality contrast media cost much more than conventional high-osmolality formulations but cause fewer adverse reactions. However, most of these reactions are mild and easily treated, and do not affect the outcome of the procedure. Whether these additional clinical benefits justify the added cost is a crucial question which has not been answered. This review introduces some of the economic and clinical issues on which the choice of contrast media should be based. Low-osmolality contrast agents are not cost effective considering current pricing strategies and current inability to select patients at increased risk of an adverse event. Therefore, a better understanding of these adverse events and their mechanism takes on added importance.