LOW-OSMOLAR CONTRAST-MEDIA IN THE 1990S - GUIDELINES FOR UROGRAPHY INA COST-SENSITIVE ENVIRONMENT

OBJECTIVES. The author reviews the clinical, ethical, medicolegal, and economic consequences of the routine versus limited use of low-osmola r contrast media for patients undergoing urographic and other radiolog ic studies. METHODS. A comprehensive review of the literature since th e introduction of low-osmolar contrast media was conducted, focussing on medical decision making and the economic impact of those decisions on radiologic studies requiring the administration of water-soluble co ntrast agents. RESULTS. Compared with high-osmolar ionic contrast medi a, routine use of low-osmolar agents for intravascular injection durin g diagnostic imaging results in fewer idiosyncratic reactions in patie nts and potentially less renal injury in a subgroup of critically ill patients. The high cost of low-osmolar agents relative to the overall cost of the examination has prevented the universal adoption of this c lass of agents in the United States. CONCLUSIONS. Economic pressures o n private and government-based insurance plans, as well as on managed- care systems responsible for a variety of patient populations, continu e to limit the availability of low-osmolar agents to the individual pa tient.