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Low osmolar (non-ionic) contrast media versus high osmolar (ionic) contrast media in intravenous urography and
1Department of Radiology, Chulalongkorn Hospital, Bangkok, Thailand.
Insights
Comparing contrast media policies for urography and CT scans, using low osmolar contrast media (LOCM) for high-risk patients is more cost-effective than using high osmolar contrast media (HOCM) for all. This strategy saves costs and improves patient outcomes.
Area of Science:
- Radiology and Medical Imaging
- Health Economics
- Public Health Policy
Background:
- Intravenous contrast media are essential for urography and enhanced computed tomography (CT) scans.
- High osmolar contrast media (HOCM) have been the historical standard, but concerns about adverse events and cost-effectiveness exist.
- Low osmolar contrast media (LOCM) offer potential safety benefits but at a higher initial cost.
Purpose of the Study:
- To analyze the cost-effectiveness of three intravenous contrast media policies for urography and enhanced CT.
- To compare using HOCM for all patients versus LOCM for all patients, and LOCM only for high-risk patients.
- To evaluate these policies from both societal and hospital perspectives.
Main Methods:
- Analysis of data from 6,242 patients undergoing urography and enhanced CT at Chulalongkorn Hospital in 1989.
- Calculation of incremental cost-effectiveness ratios (ICERs) in Baht (and USD) per healthy day saved (HDS).
- Evaluation of incremental costs per patient and sensitivity analysis based on LOCM pricing and patient payment ability.
Main Results:
- From a societal viewpoint, using LOCM for high-risk patients (Alternative #3) was significantly more cost-effective than using HOCM for all (Alternative #1), with an ICER of 12,057 Baht/HDS.
- Alternative #3 also demonstrated better cost-effectiveness for fatal cases and lower incremental costs per patient compared to Alternative #2 (LOCM for all).
- From a hospital viewpoint, Alternative #3 yielded an ICER of 6,127 Baht/HDS, substantially lower than Alternative #2 (13,744 Baht/HDS).
Conclusions:
- The policy of using low osmolar contrast media (LOCM) selectively for high-risk patients (Alternative #3) presents a more cost-effective strategy for urography and enhanced CT.
- This approach offers significant cost savings and improved efficiency from both societal and hospital perspectives compared to universal HOCM or LOCM use.
- Implementing Alternative #3 is recommended, particularly if LOCM prices decrease significantly and patients can afford the co-payment, as indicated by sensitivity analysis.
Abstract:
The cost-effectiveness of three alternative policies for the use of intravenous contrast media for urography and enhanced computerized tomography (CT) are analyzed. Alternative #1 is to use high osmolar contrast media (HOCM) in all patients, the historical policy. Alternative #2 is to replace it with low osmolar contrast media (LOCM) in all patients. Alternative #3 is to use LOCM only in the high risk patients. Data on the 6,242 patients who underwent intravenous urography and enhanced CT at the Department of Radiology, Chulalongkorn Hospital in 1989 were used. Both societal and hospital viewpoints were analyzed. The incremental cost-effectiveness (ICE) between #2 and #1 was 26,739 Baht (US$1,070) per healthy day saved (HDS), while the ICE between #3 and #1 was 12,057 Baht (US$482) per HDS. For fatal cases only, ICE between #2 and #1 was 35,111 Baht (US$1,404) per HDS, while the ICE between #3 and #1 was 18,266 Baht (US$731) per HDS. The incremental cost (IC) per patient was 2,341 Baht (US$94) and 681 Baht (US$27) respectively. For the hospital viewpoint the ICE between #2 and #1 was 13,744 (US$550) and between #3 and #1 was 6,127 Baht (US$245) per HDS. The IC per patient was 1,203 Baht (US$48) and 346 Baht (US$14), respectively. From the sensitivity analysis, #3 should be used if the LOCM price is reduced more than 75% (equal to 626 Baht or less) and more than 80% of the patients are able to pay for the contrast media.