Contrast medium-induced adverse reactions: economic outcome
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N R Powe1, E P Steinberg, J E Erickson
1Program for Medical Technology and Practice Assessment of the Center for Hospital Finance and Management, Johns Hopkins Medical Institutions, Baltimore MD.
Insights
High-osmolality contrast media (HOM) adverse reactions are common but cost-effective. Managing these reactions is less expensive than the increased material cost of using low-osmolality contrast media (LOM).
Area of Science:
- Radiology
- Medical Economics
- Patient Safety
Background:
- High-osmolality contrast media (HOM) are associated with adverse reactions.
- Low-osmolality contrast media (LOM) have a higher material cost.
- The economic impact of managing HOM adverse reactions requires evaluation.
Purpose of the Study:
- To prospectively assess the costs associated with managing adverse reactions to HOM.
- To compare these costs with the increased material expenses of LOM.
Main Methods:
- A prospective study of 795 inpatients undergoing procedures with intravascular injection of HOM.
- Measurement and cost estimation of resources used for managing HOM-induced adverse reactions.
- Categorization of reactions by severity (Class 1, 2, 3).
Main Results:
- 51% of patients experienced adverse reactions to HOM.
- 12% of patients required resources for reaction management.
- Average hospital cost per patient for managing reactions ranged from $2.52 (Class 1) to $910 (Class 3).
- The material cost difference between HOM and LOM ranged from $93 to $179 per procedure.
Conclusions:
- The cost of managing HOM adverse reactions is significantly lower than the increased material cost of LOM.
- Universal substitution of LOM for HOM would likely result in higher overall healthcare expenditure.
- HOM remains a cost-effective choice when considering the total cost of contrast media and adverse event management.
Abstract:
Because the cost of managing an expected greater number of adverse reactions when high-osmolality contrast media (HOM) are used could offset the higher material cost of low-osmolality contrast media (LOM), a prospective study was done of 795 inpatients undergoing any of four procedures involving intravascular injection of HOM: cardiac catheterization, peripheral angiography, head computed tomography (CT), or body CT. The resources used in managing HOM-induced adverse reactions were measured, and the costs of these resources were estimated. Four hundred five patients (51%) had adverse reactions. Reactions were grouped into three classes according to their severity. Class 1 (mild) reactions occurred in 358 patients (45%), class 2 (moderate) reactions occurred in 44 patients (6%), and class 3 (severe) reactions occurred in three patients (0.4%). Ninety-nine patients (12%) consumed resources as a result of an adverse reaction. The average cost of these resources per patient undergoing examination was $1.07 to the radiology department, $5.83 to the hospital, and $12.93 to a charge-paying insurer. Mean (+/- standard deviation) cost to the hospital for managing class 1, class 2, and class 3 reactions were $2.52 +/- $5.33, $24 +/- $54, and $910 +/- $749, respectively. By comparison, the difference in material cost of HOM versus LOM ranged from $93 for body CT to $179 for cardiac catheterization. Even if LOM were to induce no adverse reactions, the increased material cost associated with universal substitution of LOM for HOM would be greater than the expected cost of managing adverse reactions when HOM are used.