title: Effect of Fixed-Volume and Weight-Based Dosing Regimens on the Cost and Volume of Administered Iodinated Contrast Material at Abdominal CT.
abstract: OBJECTIVE
  To determine the magnitude of subject-level and population-level cost savings that could be realized by moving from fixed-volume low-osmolality iodinated contrast material administration to an effective weight-based dosing regimen for contrast-enhanced abdominopelvic CT.
  
  
  METHODS
  HIPAA-compliant, institutional review board-exempt retrospective cohort study of 6,737 subjects undergoing contrast-enhanced abdominopelvic CT from 2014 to 2015. Subject height, weight, lean body weight (LBW), and body surface area (BSA) were determined. Twenty-six volume- and weight-based dosing strategies with literature support were compared with a fixed-volume strategy used at the study institution: 125 mL 300 mgI/mL for routine CT, 125 mL 370 mgI/mL for multiphasic CT (single-energy, 120 kVp). The predicted population- and subject-level effects on cost and contrast material utilization were calculated for each strategy and sensitivity analyses were performed.
  
  
  RESULTS
  Most subjects underwent routine CT (91% [6,127/6,737]). Converting to lesser-volume higher-concentration contrast material had the greatest effect on cost; a fixed-volume 100 mL 370 mgI/mL strategy resulted in $132,577 in population-level savings with preserved iodine dose at routine CT (37,500 versus 37,000 mgI). All weight-based iodine-content dosing strategies (mgI/kg) with the same maximum contrast material volume (125 mL) were predicted to contribute mean savings compared with the existing fixed-volume algorithm ($4,053-$116,076/strategy in the overall study population, $1-$17/strategy per patient). Similar trends were observed in all sensitivity analyses.
  
  
  CONCLUSIONS
  Large cost and material savings can be realized at abdominopelvic CT by adopting a weight-based dosing strategy and lowering the maximum volume of administered contrast material.
authors.affiliation: Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan; Department of Urology, University of Michigan Health System, Ann Arbor, Michigan; Michigan Radiology Quality Collaborative, Ann Arbor, Michigan. Electronic address: matdaven@med.umich.edu.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Davenport
authors.affiliation: Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan; Michigan Radiology Quality Collaborative, Ann Arbor, Michigan.
authors.forename: Kushal R
authors.initials: KR
authors.lastname: Parikh
authors.affiliation: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: William W
authors.initials: WW
authors.lastname: Mayo-Smith
authors.affiliation: Department of Radiology, Yale University School of Medicine, New Haven Connecticut.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Israel
authors.affiliation: Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan; Michigan Radiology Quality Collaborative, Ann Arbor, Michigan.
authors.forename: Richard K J
authors.initials: RK
authors.lastname: Brown
authors.affiliation: Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: James H
authors.initials: JH
authors.lastname: Ellis
mesh_terms: D001827:Body Height; D001830:Body Surface Area; D001835:Body Weight; D003287:Contrast Media / Q000008:administration & dosage* / Q000191:economics*; D017046:Cost Savings; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007455:Iodine / Q000008:administration & dosage* / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011860:Radiography, Abdominal / Q000191:economics*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics*
chemical_list: D003287:Contrast Media; D007455:Iodine
keywords: CT; Quality assurance; contrast material; cost; weight-based