title: Cost-effectiveness and patient tolerance of low-attenuation oral contrast material: milk versus VoLumen.
abstract: OBJECTIVE
  The purpose of our study was to prospectively compare the cost, effectiveness, and patient tolerance of milk and VoLumen, a 0.1% barium suspension, in patients undergoing abdominal and pelvic CT with oral and i.v. contrast media.
  
  
  METHODS
  Two hundred fifteen consecutive outpatients were randomly assigned to receive either whole milk (n = 115) or VoLumen (n = 100). Results were independently reviewed by two radiologists who were blinded to the oral contrast agent used. Degree of bowel distention was qualitatively scored on a 4-point scale, and bowel wall visibility was graded qualitatively on a yes-or-no basis. A questionnaire regarding oral contrast tolerability was provided to each patient. Cost comparison of the two agents was performed.
  
  
  RESULTS
  No statistically significant differences were seen between whole milk and VoLumen with respect to degree of bowel distention and mural visualization for all segments of bowel studied (p > 0.05 for both reviewers). Significantly more patients ranked milk as pleasant in taste compared with VoLumen (p < 0.0001). More patients preferred milk compared with VoLumen (p < 0.0001). Milk was better tolerated than VoLumen, with fewer abdominal side effects, including abdominal discomfort (p = 0.019), cramping (p = 0.019), nausea (p = 0.016), and diarrhea (p = 0.0002). The cost per patient for VoLumen is $18 compared with $1.48 for milk.
  
  
  CONCLUSIONS
  Whole milk is comparable to VoLumen with respect to bowel distention and bowel wall visualization and has a lower cost, better patient acceptance, and fewer adverse symptoms. Milk is a cost-effective alternative to VoLumen as a low-attenuation oral contrast agent.
authors.affiliation: Department of Radiology, St. Luke's-Roosevelt Hospital Center, 1000 Tenth Ave., Rm. 4C-12, New York, NY 10019, USA. ck2182@columbia.edu <ck2182@columbia.edu>
authors.forename: Chi Wan
authors.initials: CW
authors.lastname: Koo
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Shah-Patel
authors.forename: Jeanne W
authors.initials: JW
authors.lastname: Baer
authors.forename: David H
authors.initials: DH
authors.lastname: Frager
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001466:Barium Sulfate / Q000008:administration & dosage / Q000009:adverse effects* / Q000191:economics*; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D008892:Milk / Q000009:adverse effects* / Q000191:economics*; D011446:Prospective Studies; D016037:Single-Blind Method; D013535:Suspensions; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D013535:Suspensions; D001466:Barium Sulfate; D007472:Iohexol; C038192:iopromide