ADVERSE EVENTS AND COST SAVINGS 3 YEARS AFTER IMPLEMENTATION OF GUIDELINES FOR OUTPATIENT CONTRAST AGENT USE

The ability of guidelines limiting the use of low-osmolality contrast media (LOCM) to save money without jeopardizing patient care was studi ed. In February 1993 an academic medical center implemented guidelines to reduce the use of LOCM for outpatient computed tomography and excr etory urography; the guidelines limited LOCM to patients at high risk of adverse reactions to contrast agents. Data on contrast media receiv ed and frequency of adverse events were compiled from billing sheets a nd incident reports for March 1993 through February 1996. The number o f patients receiving LOCM over the three years was 1325, and the numbe r receiving high-osmolality contrast media (HOCM) was 4435. Of the HOC M recipients, 165 (3.7%) had adverse reactions; 0.4% of these reaction s were major, 3.1% were minor, and 0.2% were extravasations. Among LOC M-treated patients, 35 (2.7%) had adverse reactions; 0.5% were major, 1.7% were minor, and 0.5% were extravasation. The only significant dif ference 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 recei ved LOCM, the total cost of contrast agents would have been $603,723; thus, the estimated drug cost saving was $396,540, or $132,180 annuall y. With costs of treating adverse events factored in, the net annual c ost saving was $132,093. Guidelines limiting the use of LOCM to high-r isk patients saved an academic medical center an estimated $132,093 an nually in drug costs for specific outpatient imaging procedures, witho ut adversely affecting patient care.