NET COSTS FROM 3 PERSPECTIVES OF USING LOW VERSUS HIGH-OSMOLALITY CONTRAST-MEDIUM IN DIAGNOSTIC ANGIOCARDIOGRAPHY

Objectives. We conducted an economic analysis to assess the extent to which a reduction in adverse drug reactions induced by low osmolality compared with high osmolality contrast media during diagnostic angioca rdiography would result in savings to hospitals, society and third-par ty payers that would offset the substantially higher price of low osmo lality contrast medium. Background. Substitution of low osmolality for high osmolality contrast media in the approximately 1 million diagnos tic angiocardiographic procedures performed each year in the United St ates could substantially increase health care costs. Cost-effectivenes s estimates should include savings that might occur through reduced co sts of managing adverse drug reactions. Methods. In a randomized clini cal trial of 505 persons undergoing diagnostic angiography with either high osmolality or low osmolality contrast medium, we measured and co mpared 1) material costs of contrast media, and 2) costs from three pe rspectives of incremental resources used to manage contrast-related ad verse drug reactions. We also performed sensitivity analyses to examin e the effect of different assumptions with regard to relative risk, ab solute risk and costs of adverse drug reactions on estimates of net co st of use of high osmolality and low osmolality contrast media. Result s. One-hundred thirty-seven (54.2%) of 253 patients receiving high osm olality contrast medium and 44 (17.5%) of 252 patients receiving low o smolality contrast medium experienced adverse drug reactions. The aver age cost (from society's perspective) of resources used to manage adve rse drug reactions per patient undergoing angiography was significantl y (p = 0.0001) greater for high osmolality (mean $249) versus low osmo lality (mean $92) contrast medium. Differential costs (from the hospit al's perspective) were $67 greater for high osmolality contrast medium . Charges and professional fees (from the payer's perspective) were $1 82 greater for high osmolality (mean $312) than for low osmolality (me an $130) contrast medium (p = 0.42, NS). The higher differential and a verage costs of managing adverse drug reactions with high osmolality c ontrast medium offset 33% and 75%, respectively, of the $207 differenc e in mean material costs, but these estimates are sensitive to infrequ ent high cost cases. Conclusions. Although low osmolality contrast med ium is not cost-saving in diagnostic angiocardiography, its higher pri ce is partially offset by lower management costs of adverse drug react ions. The cost offset for the hospital is lower than that for society and may not be realized by third-party payers. These methods and resul ts may be useful in establishing clinical and payment guidelines for u se of alternative contrast media in diagnostic angiocardiography.