title: Cost-effectiveness of iso- versus low-osmolality contrast media in outpatients with high risk of contrast medium-induced nephropathy.
abstract: BACKGROUND
  Contrast media can cause acute renal failure by direct toxic effects on the tubular cells and kidney ischemia. Diabetics and hospitalized patients have a greater risk of developing contrast-induced nephropathy than the general population.
  
  
  OBJECTIVE
  The cost effectiveness of iso and low-osmolality contrast media was assessed in high risk outpatients.
  
  
  METHODS
  The analysis was based on a systematic literature review comparing the nephrotoxic effects of iso- to low-osmolality contrast media. Only direct costs were considered; these were obtained from the official tariff manual. Incremental cost-effectiveness ratios, efficiency curves and acceptability curves were calculated. Univariate sensitivity analyses were performed for costs and effects, as well as probabilistic analyses. Zero and 3% discounts were applied to results. The cost-effectiveness threshold was equal to the per capita GDP per life-year gained.
  
  
  RESULTS
  Alternatives with Iopamidol and Iodixanol are preferable to the others, because both reduce risk of contrast-induced nephropathy and are less costly. The incremental cost-effectiveness of the Iodixanol alternative compared to the Iopamidol alternative is US$ 14,660 per additional life year gained; this is more than twice the threshold.
  
  
  CONCLUSIONS
  The low-osmolality contrast medium, Iopamidol, appears to be cost-effective when compared with Iohexol or other low-osmolality contrast media (Iopromide, Iobitridol, Iomeprol, Iopentol and Ioxilan) in contrast-induced nephropathy, high-risk outpatients. The choice of the iso-osmolality contrast medium, Iodixanol, depends on its cost per vial and on the willingness to pay.
authors.affiliation: Facultad de Ciencias Económicas, Universidad Nacional de Colombia, Bogotá, DC, Colombia.
authors.forename: Liliana Alejandra
authors.initials: LA
authors.lastname: Chicaíza-Becerra
authors.forename: Mario
authors.initials: M
authors.lastname: García-Molina
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Gamboa
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D000368:Aged; D003105:Colombia / Q000453:epidemiology; D003287:Contrast Media / Q000009:adverse effects / Q000737:chemistry / Q000191:economics*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007472:Iohexol / Q000009:adverse effects / Q000031:analogs & derivatives / Q000737:chemistry / Q000191:economics; D007479:Iopamidol / Q000009:adverse effects / Q000737:chemistry / Q000191:economics; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics; D009994:Osmolar Concentration; D010045:Outpatients; D006435:Renal Dialysis / Q000191:economics / Q000706:statistics & numerical data; D012306:Risk; D014283:Triiodobenzoic Acids / Q000009:adverse effects / Q000737:chemistry / Q000191:economics
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C093233:iobitridol; D007472:Iohexol; C038192:iopromide; C053571:iopentol; C055357:ioxilan; C044834:iodixanol; D007479:Iopamidol