An economic analysis of strategies for the use of contrast media for diagnostic cardiac catheterization.
A decision tree model was used to estimate the incremental cost per quality-adjusted life year (QALY) of low- as opposed to high-osmolality contrast media for cardiac angiography. Analyses were done from the viewpoints of a third-party payer and society using data from a randomized trial and the literature. Assuming low-osmolality media reduce the risk of myocardial infarction and stroke, the incremental cost per QALY gained with these media is $17,264 in high-risk or $47,874 in low-risk patients for a third-party payer. From a societal viewpoint, the corresponding costs are $649 and $35,509. These estimates are sensitive to the cost and volume of the contrast medium employed and to the estimate of reduction in severe adverse events with low-osmolality media. The authors conclude that, in the context of restricted budgets, limiting the use of low-osmolality media to high-risk patients is justifiable, as the incremental cost per QALY in high-risk patients may be reasonable and it is not certain that low-osmolality media prevent severe or fatal events. A considerable reduction in the cost per QALY gained is possibly by minimizing the volume of contrast medium used.
Barrett
B J
BJ
Division of Clinical Epidemiology, Memorial University of Newfoundland, St. John's, Canada.
Parfrey
P S
PS
Foley
R N
RN
Detsky
A S
AS
D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control; D003287:Contrast Media / Q000009:adverse effects / Q000191:economics*; D017023:Coronary Angiography / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003663:Decision Trees; D006331:Heart Diseases / Q000175:diagnosis; D006801:Humans; D008017:Life Expectancy; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D009325:Nausea / Q000209:etiology / Q000517:prevention & control; D009994:Osmolar Concentration; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D012680:Sensitivity and Specificity
D003287:Contrast Media