Use of low-osmolality contrast media in a price-sensitive environment

Over the past 3 years, three radiographic contrast media that are lower in osmolality than traditional contrast media have become available in the United States. These lower osmolality media have been reported to produce fewer adverse reactions than the higher osmolality media, but they cost 10 to 20 times more than higher osmolality media. To explore hospital and physician decision-making regarding the use of lower osmolality media in the increasingly price-sensitive health-care environment, we surveyed the 40 hospitals in the United States that received the most funding from the National Institutes of Health in 1985. Radiologists in 27 (68%) of the hospitals responded. Of these, 93% believed lower osmolality media improve the quality of patient care. However, nearly half of responding institutions limited the use of lower osmolality media. On average, in 1986 lower osmolality media were used in 9% of procedures in which contrast media were injected intravascularly. The decision to limit use was made primarily by radiologists, rather than hospital administrators, and was based on concerns regarding the high price of lower osmolality media. Twelve respondents had developed guidelines for appropriate use of lower osmolality media, but only 25% of these had developed mechanisms to ensure or increase compliance with those guidelines. Only one respondent (4%) reported that he routinely informs patients of the issues and tradeoffs involved in deciding whether to use lower or higher osmolality media. We conclude that cost is an important factor in physicians' and hospitals' choices of contrast media and that increased attention should be given to defining appropriate procedures to follow when informed consent is obtained for the use of contrast material.