AN ECONOMIC-ANALYSIS OF STRATEGIES FOR THE USE OF CONTRAST-MEDIA FOR DIAGNOSTIC CARDIAC-CATHETERIZATION

A decision tree model was used to estimate the incremental cost per qu ality-adjusted life year (QALY) of low- as opposed to high-osmolality contrast media for cardiac angiography. Analyses were done from the vi ewpoints of a third-party payer and society using data from a randomiz ed trial and the literature. Assuming low-osmolality media reduce the risk of myocardial infarction and stroke, the incremental cost per QAL Y gained with these media is $17,264 in high-risk or $47,874 in low-ri sk patients for a third-party payer. From a societal viewpoint, the co rresponding costs are $649 and $35,509. These estimates are sensitive to the cost and volume of the contrast medium employed and to the esti mate of reduction in severe adverse events with low-osmolality media. The authors conclude that, in the context of restricted budgets, limit ing the use of low-osmolality media to high-risk patients is justifiab le, as the incremental cost per QALY in high-risk patients may be reas onable and it is not certain that low-osmolality media prevent severe or fatal events. A considerable reduction in the cost per QALY gained is possible by minimizing the volume of contrast medium used.