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Adverse events and cost savings three years after implementation of guidelines for outpatient contrast-agent use
1Medication Information and Policy Development Service, University Medical Center Corp., Tucson, AZ, USA. grant@pharmacy.arizona.edu.
Insights
Implementing guidelines to limit low-osmolality contrast media (LOCM) use in outpatient imaging saved an academic medical center over $132,000 annually. This cost-saving strategy did not compromise patient care or increase adverse events, demonstrating effective resource management.
Area of Science:
- Radiology
- Health Economics
- Patient Safety
Background:
- Academic medical centers face pressure to control healthcare costs.
- Contrast media selection impacts both patient safety and institutional budgets.
- Low-osmolality contrast media (LOCM) are generally safer but more expensive than high-osmolality contrast media (HOCM).
Purpose of the Study:
- To evaluate the financial impact of implementing guidelines restricting LOCM use.
- To assess whether these cost-saving measures affected patient safety and adverse events.
- To determine the net annual cost savings from optimizing contrast media utilization.
Main Methods:
- An academic medical center implemented guidelines prioritizing HOCM for most outpatient CT and urography, reserving LOCM for high-risk patients.
- Data on contrast media type, patient risk factors, and adverse events were collected over three years (March 1993-February 1996).
- Cost analysis compared actual spending on HOCM and LOCM with a hypothetical scenario of universal LOCM use.
Main Results:
- Adverse reaction rates were similar between HOCM (3.7%) and LOCM (2.7%) recipients, with no significant difference in major events.
- The cost of HOCM was substantially lower than LOCM, leading to significant drug cost savings under the new guidelines.
- Estimated annual savings reached $132,093, including the costs associated with managing adverse events.
Conclusions:
- Guidelines restricting LOCM to high-risk patients are effective in reducing contrast media costs.
- This strategy achieves significant financial savings without negatively impacting patient safety or increasing adverse event frequency.
- Optimized contrast media protocols offer a viable approach to cost containment in diagnostic imaging.
Abstract:
The ability of guidelines limiting the use of low-osmolality contrast media (LOCM) to save money without jeopardizing patient care was studies. In February 1993 an academic medical center implemented guidelines to reduce the use of LOCM for outpatient computed tomography and excretory urography; the guidelines limited LOCM to patients at high risk of adverse reactions to contrast agents. Data on contrast media received and frequency of adverse events were compiled from billing sheets and incident reports for March 1993 through February 1996. The number of patients receiving LOCM over the three years was 1325, and the number receiving high-osmolality contrast media (HOCM) was 4435. Of the HOCM recipients, 165 (3.7%) had adverse reactions; 0.4% of these reactions were major, 3.1% were minor, and 0.2% were extravasations. Among LOCM-treated patients, 35 (2.7%) had adverse reactions; 0.5% were major, 1.7% were minor, and 0.5% were extravasations. The only significant difference in adverse effects between the groups was in the frequency of minor reactions. The costs of HOCM and LOCM over the three years were $54,660 and $152,523, respectively. Had 90% of the 5760 patients received LOCM, the total cost of contrast agents would have been $603,723; thus, the estimated drug cost saving was $396,540, or $132,180 annually. With costs of treating adverse events factored in, the net annual cost saving was $132,093. Guidelines limiting the use of LOCM to high-risk patients saved an academic medical center an estimated $132,093 annually in drug costs for specific outpatient imaging procedures, without adversely affecting patient care.