Contrast medium-induced adverse reactions: economic outcome.
Because the cost of managing an expected greater number of adverse reactions when high-osmolality contrast media (HOM) are used could offset the higher material cost of low-osmolality contrast media (LOM), a prospective study was done of 795 inpatients undergoing any of four procedures involving intravascular injection of HOM: cardiac catheterization, peripheral angiography, head computed tomography (CT), or body CT. The resources used in managing HOM-induced adverse reactions were measured, and the costs of these resources were estimated. Four hundred five patients (51%) had adverse reactions. Reactions were grouped into three classes according to their severity. Class 1 (mild) reactions occurred in 358 patients (45%), class 2 (moderate) reactions occurred in 44 patients (6%), and class 3 (severe) reactions occurred in three patients (0.4%). Ninety-nine patients (12%) consumed resources as a result of an adverse reaction. The average cost of these resources per patient undergoing examination was $1.07 to the radiology department, $5.83 to the hospital, and $12.93 to a charge-paying insurer. Mean (+/- standard deviation) cost to the hospital for managing class 1, class 2, and class 3 reactions were $2.52 +/- $5.33, $24 +/- $54, and $910 +/- $749, respectively. By comparison, the difference in material cost of HOM versus LOM ranged from $93 for body CT to $179 for cardiac catheterization. Even if LOM were to induce no adverse reactions, the increased material cost associated with universal substitution of LOM for HOM would be greater than the expected cost of managing adverse reactions when HOM are used.
Program for Medical Technology and Practice Assessment of the Center for Hospital Finance and Management, Johns Hopkins Medical Institutions, Baltimore MD.
N R
NR
Powe
E P
EP
Steinberg
J E
JE
Erickson
R D
RD
Moore
C R
CR
Smith
R I
RI
White
J A
JA
Brinker
E K
EK
Fishman
S J
SJ
Zinreich
M L
ML
Kinnison
D000328:Adult; D000792:Angiography; D006328:Cardiac Catheterization; D003287:Contrast Media / Q000009:adverse effects*; D003365:Costs and Cost Analysis; D006746:Hospital Bed Capacity, 500 and over; D006748:Hospital Departments / Q000191:economics*; D006801:Humans; D007350:Insurance, Hospitalization / Q000191:economics*; D007357:Insurance, Physician Services / Q000191:economics*; D008396:Maryland; D009994:Osmolar Concentration; D011446:Prospective Studies; D011872:Radiology Department, Hospital / Q000191:economics*; D012107:Research Design; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed
D003287:Contrast Media