AN OPTIMAL DUAL-SIZE VIAL SYSTEM FOR THE COST-EFFECTIVE USAGE OF ADENOSCAN

Background. Adenoscan (Fujisawa USA, Inc., Deerfield, Ill,) has been i nitially packaged in a 30 mi glass vial for single use only because it contains no preservative, This restricted usage has generated conside rable waste and high cost for the patient, Although the new 20 mi vial of Adenoscan provides some reduction in waste, the savings offered by the 20 mi and 30 mi vial system is still not optimal, The purpose of this study was to investigate an optimal dual-size vial system that wo uld provide limited amounts of waste while maintaining its practicalit y to satisfy different patient populations. Materials and Results, The least waste for each potential combination (n = 344) of two vials was calculated by assuming that patient weights (30 to 200 kg) follow a n ormal distribution. The 6 mi and 15 mi vial combination had the least expected waste for lighter patient populations, and the 9 mi and 15 mi vial system had the least expected waste for heavier populations. The calculated wastes for 4207 patients (83 +/- 19 kg) undergoing adenosi ne stress myocardial perfusion studies at the Mayo Clinic were 10.5 +/ - 9.3 ml (30 mi vial), 5.1 +/- 2.9 mi (20 mi and 30 mi vial system), 1 .6 +/- 1.0 mi (6 mi and 15 mi vial system), and 1.8 +/- 1.2 mi (9 mi a nd 15 mi vial system). Conclusions. In general, both the 6 mi and 15 m i and 9 mi and 15 mi vial systems perform better than either the singl e 30 mi vial or the 20 mi and 30 mi vial system. Furthermore, the 6 mi and 15 mi vial combination offers the lowest expected waste for the a ctual patient population that underwent the adenosine stress myocardia l perfusion imaging studies at our institution.