Effect of iodinated contrast shortage on repeat CT imaging and ED spending: a retrospective analysis

To evaluate the impact of an iodinated contrast media (ICM) shortage on repeat CT imaging, length of stay (LOS), and total healthcare spending in a mid-sized academic medical center, focusing on abdominal/pelvis CT.

Retrospective cohort analysis of electronic health records from August 1, 2021 to February 15, 2023. Four shortage phases were defined: Pre-Shortage, Wash-In, Rationing, and Post-Shortage. The primary exposure was receipt of CT with contrast vs. CT without contrast at initial imaging. Outcomes included number of follow-up scans per patient, LOS, and total costs within two months after initial imaging. Multivariable models adjusted for age, sex, comorbidities, and ED presentation characteristics to estimate associations between initial contrast status and subsequent imaging, LOS, and costs.

Among 12,232 CT encounters, 38-55% of initial scans occurred without contrast during shortage phases. The proportion of patients requiring multiple follow-up scans increased in the shortage periods, with a notable rise during Rationing. Median LOS was longer for patients who had non-contrast initial CT compared with contrast-enhanced CT in the same period. Total peri-imaging costs rose in shortage phases, driven largely by additional imaging and extended LOS. After return to baseline supply, follow-up imaging and LOS metrics approached pre-shortage levels, yet costs remained elevated in the short term.

The ICM shortage and associated rationing protocols substantially changed contrast use. Contrary to our initial hypothesis, adjusted repeat imaging was lower during rationing than during the pre- and post-shortage periods. When repeat imaging occurred, it was associated with longer outpatient and inpatient LOS. Contrast use and repeat imaging were also associated with differences in billed charges. These findings highlight the importance of evaluating both imaging utilization and downstream resource use during future ICM disruptions.