title: Low-osmolar contrast media in the 1990s. Guidelines for urography in a cost-sensitive environment.
abstract: OBJECTIVE
  The author reviews the clinical, ethical, medicolegal, and economic consequences of the routine versus limited use of low-osmolar contrast media for patients undergoing urographic and other radiologic studies.
  
  
  METHODS
  A comprehensive review of the literature since the introduction of low-osmolar contrast media was conducted, focussing on medical decision making and the economic impact of those decisions on radiologic studies requiring the administration of water-soluble contrast agents.
  
  
  RESULTS
  Compared with high-osmolar ionic contrast media, routine use of low-osmolar agents for intravascular injection during diagnostic imaging results in fewer idiosyncratic reactions in patients and potentially less renal injury in a subgroup of critically ill patients. The high cost of low-osmolar agents relative to the overall cost of the examination has prevented the universal adoption of this class of agents in the United States.
  
  
  CONCLUSIONS
  Economic pressures on private and government-based insurance plans, as well as on managed-care systems responsible for a variety of patient populations, continue to limit the availability of low-osmolar agents to the individual patient.
authors.affiliation: Department of Diagnostic Radiology, University of Tennessee-Memphis College of Medicine 38163.
authors.forename: M L
authors.initials: ML
authors.lastname: Gavant
mesh_terms: D003287:Contrast Media / Q000009:adverse effects / Q000191:economics; D004992:Ethics, Medical; D006801:Humans; D009994:Osmolar Concentration; D014567:Urography / Q000191:economics
chemical_list: D003287:Contrast Media