Authors' objectives:

To provide an overview about the benefits and costs of using two different low osmolar contrast utilization strategies (universal or selective). Literature review, information synthesis, and cost-benefit analysis.

Authors' results and conclusions: Currently, there are two types of iodinated radiological contrast agents that differ, mainly, on its osmolality: high osmolality agents (conventional) and low osmolality agents (new). Both classes of agents perform safely and well. Nevertheless, low-osmolality contrast medica (LOCM) are safer and better tolerated than conventional media. However, this better performance is associated with a greater cost. The issue of deciding between the two classes of contrasts is complex because of the trade-off between their cost and their safety. Severe adverse contrast reactions are the main issue when considering the different strategies of utilization of this new agent (universal or selective). Although LOCM reduces its number, the incidence and absolute risk is very low. There is a group of patients who are prone to develop an adverse contrast reaction due to the presence of specific risk factors. This target population would obtain benefits from LOCM at an affordable cost. There are some studies that suggest that the main risk to develop a contrast medical reaction is the type of contrast. However, methodologic problems in these studies make it difficult to ascertain whether there is any difference between LOCM and HOCM in the risk of serious adverse reactions in low risk patients. In Catalonia, the hospital price of contrast is approximately 890 PTA/100 ml and 8.612 PTA/100 ml for HOCM and LOCM respectively (1993 prices). During 1992, 91% of the radiological procedures with contrast were done with LOCM. Considering the hypothesis and assumptions of the study, an universal LOCM strategy would cost 942,446,040 PTA/100,000 procedures; a selective strategy (LOCM for high risk patients and HOCM for low risk patients) would cost 251,206,192 PTA/100,000 procedures. The report recommends that a selective strategy in the utilization of radiological contrasts, based on the results of this analysis, be used. Guidelines addressing the specific guidelines for selective use of LOCM should be developed among professionals.

Authors' recommendations: Nowadays, due to the constraints in health resources, it seems more reasonable to implement a selective strategy of LOCM utilization. This strategy would lead to a good clinical practice to a distributive ethic of the resources with affordable costs. Also, clinical guidelines for selective use of LOCM should be developed among Catalan professionals.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.gencat.net/salut/depsan/units/aatrm/html/en/dir393/doc7921.ht ml

Year Published: 1993

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Qualitat i Avaluacio Sanitries de Catalunya

Contact Address: Antoni Parada, CAHTA, Roc Boronat, 81-95 (2nd floor), 08005 Barcelona, Spain, Tel. +34 935 513 928, Fax: +34 935 517 510

Contact Name: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Contact Email: direccio@aatrm.catsalut.net / aparada@aatrm.catsalut.net

Copyright: Catalan Agency for Health Technology Assessment and Research