Use of an intravenous contrast agent (Optison) to enhance echocardiography: efficacy and cost implications. Optison Multicenter Study Group.
OBJECTIVE
To compare the overall diagnostic costs associated with non-contrast and contrast echocardiography.


METHODS
Phase III clinical trial.


METHODS
In a secondary analysis of data from a phase III clinical trial of the intravenous contrast agent Optison, we compared the costs associated with obtaining a diagnosis in 203 patients who underwent non-contrast and contrast echocardiography. Costs for the initial test and any follow-up tests were derived from adjusted Medicare charges and a transition-1 microcost accounting system.


RESULTS
Diagnostic yield from echocardiograms was 87% with the use of Optison (3 mL) and 49% when no contrast agent was used (P < 0.001). Because technically inadequate echocardiograms were more common in the non-contrast group, follow-up testing was recommended for 42% of patients in this group compared with 12% of those who had undergone a contrast-enhanced echocardiogram (P < 0.001). Although use of Optison increased the initial diagnostic cost by $125, overall costs were 17% lower when Optison was used (P < 0.0001). Use of Optison also resulted in a 17% to 70% decrease in confirmatory transesophageal echocardiography, catheterization, and nuclear studies. Optison improved diagnostic accuracy by 2.7-fold in patients with an initial non-diagnostic echocardiogram, resulting in a substantial cost savings of $269 per patient.
Shaw
L J
LJ
Center for Clinical Evaluation Science, Emory University, Atlanta, GA 30322, USA. lshaw@cces.emory.edu
Gillam
L
L
Feinstein
S
S
Dent
J
J
Plotnick
G
G
D009202:Cardiomyopathies / Q000000981:diagnostic imaging; D003287:Contrast Media; D003362:Cost-Benefit Analysis; D003952:Diagnostic Imaging; D004341:Drug Evaluation; D004452:Echocardiography / Q000191:economics / Q000379:methods* / Q000592:standards; D006801:Humans; D007275:Injections, Intravenous; D008171:Lung Diseases / Q000000981:diagnostic imaging; D006278:Medicare; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014481:United States
D003287:Contrast Media