Skip to main content
PMC home page
CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1989 Feb 15;140(4):389–395.

Nonionic contrast media: economic analysis and health policy development.

V Goel 1, R B Deber 1, A S Detsky 1
PMCID: PMC1268661  PMID: 2492446

Abstract

The replacement of old radiologic contrast media with supposedly safer but more expensive media has created a dilemma for radiologists and hospital administrators. To quantitate the nature of this trade-off we performed a cost-utility analysis using optimistic assumptions that favoured the new media. A complete conversion to the new media would result in an incremental cost of at least $65,000 to gain 1 quality-adjusted life-year (QALY). For a selective strategy in which only high-risk patients would receive the new media the cost would be about $23,000 per QALY gained. However, the incremental cost for low-risk patients is over $220,000 per QALY gained. Conversion to the new contrast media, although not necessarily the most efficient use of scarce resources, has already occurred in Ontario, primarily because of press publicity, pressure from insurers and a political unwillingness of policymakers to decide the fate of identifiable victims. We found that funding of a new intervention associated with a high cost-utility ratio rather than interventions with lower ratios might save some identifiable victims at the expense of a larger number of unidentifiable ones.

Full text

PDF
389

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ansell G., Tweedie M. C., West C. R., Evans P., Couch L. The current status of reactions to intravenous contrast media. Invest Radiol. 1980 Nov-Dec;15(6 Suppl):S32–S39. doi: 10.1097/00004424-198011001-00010. [DOI] [PubMed] [Google Scholar]
  2. Bettmann M. A. Radiographic contrast agents--a perspective. N Engl J Med. 1987 Oct 1;317(14):891–893. doi: 10.1056/NEJM198710013171408. [DOI] [PubMed] [Google Scholar]
  3. Detsky A. S., Stacey S. R., Bombardier C. The effectiveness of a regulatory strategy in containing hospital costs. The Ontario experience, 1967-1981. N Engl J Med. 1983 Jul 21;309(3):151–159. doi: 10.1056/NEJM198307213090306. [DOI] [PubMed] [Google Scholar]
  4. Evens R. G. Economic impact of low-osmolality contrast agents on radiology procedures and departments. Radiology. 1987 Jan;162(1 Pt 1):267–268. doi: 10.1148/radiology.162.1.3786775. [DOI] [PubMed] [Google Scholar]
  5. Fischer H. W., Spataro R. F., Rosenberg P. M. Medical and economic considerations in using a new contrast medium. Arch Intern Med. 1986 Sep;146(9):1717–1721. [PubMed] [Google Scholar]
  6. Grainger R. G. Radiological contrast media. Clin Radiol. 1987 Jan;38(1):3–5. doi: 10.1016/s0009-9260(87)80378-1. [DOI] [PubMed] [Google Scholar]
  7. Hobbs B. B. The use of low osmolality contrast agents. Can Assoc Radiol J. 1986 Jun;37(2):67–68. [PubMed] [Google Scholar]
  8. Lasser E. C., Berry C. C., Talner L. B., Santini L. C., Lang E. K., Gerber F. H., Stolberg H. O. Pretreatment with corticosteroids to alleviate reactions to intravenous contrast material. N Engl J Med. 1987 Oct 1;317(14):845–849. doi: 10.1056/NEJM198710013171401. [DOI] [PubMed] [Google Scholar]
  9. McClennan B. L. Low-osmolality contrast media: premises and promises. Radiology. 1987 Jan;162(1 Pt 1):1–8. doi: 10.1148/radiology.162.1.3786748. [DOI] [PubMed] [Google Scholar]
  10. Shehadi W. H. Contrast media adverse reactions: occurrence, recurrence, and distribution patterns. Radiology. 1982 Apr;143(1):11–17. doi: 10.1148/radiology.143.1.7063711. [DOI] [PubMed] [Google Scholar]
  11. Shehadi W. H., Toniolo G. Adverse reactions to contrast media: a report from the Committee on Safety of Contrast Media of the International Society of Radiology. Radiology. 1980 Nov;137(2):299–302. doi: 10.1148/radiology.137.2.7433658. [DOI] [PubMed] [Google Scholar]
  12. Torrance G. W. Measurement of health state utilities for economic appraisal. J Health Econ. 1986 Mar;5(1):1–30. doi: 10.1016/0167-6296(86)90020-2. [DOI] [PubMed] [Google Scholar]
  13. Weinstein M. C. Challenges for cost-effectiveness research. Med Decis Making. 1986 Oct-Dec;6(4):194–198. doi: 10.1177/0272989X8600600402. [DOI] [PubMed] [Google Scholar]
  14. White R. I., Jr, Halden W. J., Jr Liquid gold: low-osmolality contrast media. Radiology. 1986 May;159(2):559–560. doi: 10.1148/radiology.159.2.3515427. [DOI] [PubMed] [Google Scholar]
  15. Wolf G. L. Safer, more expensive iodinated contrast agents: how do we decide? Radiology. 1986 May;159(2):557–558. doi: 10.1148/radiology.159.2.3961192. [DOI] [PubMed] [Google Scholar]

Articles from CMAJ: Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association

RESOURCES