RESUMO
Introduction: Acute kidney injury (AKI) is a complex and common condition associated with increased morbidity, mortality, and costs. Evidence from cost-effectiveness analysis (CEA) have targeted various aspects of AKI including detection with biomarkers, treatment with renal replacement therapy, and prevention when using contrast media. However, there has not been a systematic review of these studies across the entirety of AKI.Areas covered: PubMed, Embase, and Cochrane library were used to identify CEA studies that involved AKI from 2004 onwards. These studies compared AKI treatment through renal replacement therapies (n = 6), prevention of contrast-induced-AKI (CI-AKI) using different media (n = 3), and diagnosis with novel biomarkers (n = 2). Treatment strategies for AKI focused on continuous versus intermittent renal replacement therapy. While there was no consensus, the majority of studies favored the continuous form. For contrast media, both studies found iodixanol to be cost-effective compared to iohexol for preventing CI-AKI. Additionally, novel biomarkers showed potential to be cost-effective in risk assessment and detection of AKI.Expert opinion: Consistent criteria such as a lifetime time horizon would allow for better model comparisons. Further research on clinical parameters to capture transition probabilities between stages within AKI and progression to downstream kidney disease is needed.
Assuntos
Injúria Renal Aguda/economia , Meios de Contraste/efeitos adversos , Terapia de Substituição Renal/métodos , Injúria Renal Aguda/prevenção & controle , Injúria Renal Aguda/terapia , Biomarcadores/metabolismo , Meios de Contraste/administração & dosagem , Análise Custo-Benefício , Humanos , Iohexol/administração & dosagem , Iohexol/economia , Terapia de Substituição Renal/economia , Medição de Risco , Ácidos Tri-Iodobenzoicos/administração & dosagem , Ácidos Tri-Iodobenzoicos/economiaRESUMO
PURPOSE: Contrast-induced acute kidney injury is a prominent complication following cardiac catheterization, though the risk has progressively decreased in recent times with appropriate risk stratification and use of safer contrast agents. Despite data supporting further lowering of risk with the iso-osmolar agent, iodixanol, uptake has lagged, perhaps due to increased upfront cost of this agent. We undertook an economic analysis to estimate the cost-effectiveness of a strategy utilizing iodixanol compared to using a low-osmolar contrast agent. METHODS: We created a Markov model to evaluate the two strategies, and included a differential relative risk of contrast-induced acute kidney injury, based on a systematic review of the literature. Downstream clinical events, including need for dialysis and mortality, were modeled using data from existing published literature. A third-party payer perspective was utilized for the analysis and presentation of the primary economic analysis. RESULTS: The strategy of using iodixanol dominated in both the low-risk and high-risk base case analyses. However, the difference was quite small in the low-risk scenario (lifetime cost: C$678,034 vs. C$678,059 and life expectancy: 19.80 vs. 19.72 years). The difference was more marked (life expectancy 15.65 vs. 14.15 years and cost C$680,989 vs. C$682,023) in the high-risk case analysis. This was robust across most of the variables tested in sensitivity analyses. CONCLUSION: The use of iodixanol, compared with low-osmolar contrast agents, for cardiac catheterization, results in a small benefit clinical outcomes, and in a savings in direct healthcare costs. Overall, our analysis supports the use of iodixanol for cardiac catheterization, especially in patients at high risk of acute kidney injury.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Cateterismo Cardíaco/efeitos adversos , Meios de Contraste/efeitos adversos , Custos de Cuidados de Saúde , Ácidos Tri-Iodobenzoicos/efeitos adversos , Injúria Renal Aguda/economia , Injúria Renal Aguda/epidemiologia , Canadá/epidemiologia , Cateterismo Cardíaco/economia , Angiografia Coronária/efeitos adversos , Angiografia Coronária/economia , Análise Custo-Benefício , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Diálise Renal/economia , Fatores de Risco , Taxa de Sobrevida , Ácidos Tri-Iodobenzoicos/economiaRESUMO
OBJECTIVE: To determine the net economic impact of switching from low-osmolar contrast media (LOCM) to iso-osmolar contrast media (IOCM; iodixanol) in patients undergoing inpatient coronary or peripheral angioplasty in the United States (US). METHODS: A budget impact model (BIM) was developed from a hospital perspective. Nationally representative procedural and contrast media prevalence rates, along with MARCE (major adverse renal cardiovascular event) incidence and episode-related cost data were derived from Premier Hospital Data (October 2014 to September 2015). A previously estimated relative risk reduction in MARCE associated with IOCM usage (9.3%) was applied. The higher cost of IOCM was included when calculating the net impact estimates at the aggregate, hospital type, and per hospital levels. One-way (±25%) and probabilistic sensitivity analyses identified the model's most important inputs. RESULTS: Based on weighted analysis, 513,882 US inpatient angioplasties and 35,610 MARCE cases were estimated annually. Switching to an "IOCM only" strategy from a "LOCM only" strategy increases contrast media cost, but prevents 2,900 MARCE events. The annual budget impact was an estimated saving of $30.71 million, aggregated across all US hospitals, $6,316 per hospital, or $60 per procedure. Net savings were maintained across all univariate sensitivity analyses. While MARCE/event-free cost differential was the most important factor driving total net savings for hospitals in the Northeast and West, procedural volume was important in the Midwest and rural locations. CONCLUSIONS: Switching to an "IOCM only" strategy from a "LOCM only" approach yields substantial net global savings to hospitals, both at the national level and within hospital sub-groups. Hospital administrators should maintain awareness of the factors that are likely to be more influential for their hospital and recognize that purchasing on the basis of lower contrast media cost may result in higher overall costs for patients undergoing inpatient angioplasty.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Angioplastia/métodos , Meios de Contraste/efeitos adversos , Cardiopatias/induzido quimicamente , Administração Hospitalar/economia , Injúria Renal Aguda/economia , Orçamentos/estatística & dados numéricos , Meios de Contraste/classificação , Meios de Contraste/economia , Custos e Análise de Custo , Feminino , Cardiopatias/economia , Humanos , Pacientes Internados , Masculino , Modelos Econométricos , Método de Monte Carlo , Concentração Osmolar , Características de Residência/estatística & dados numéricos , Ácidos Tri-Iodobenzoicos/efeitos adversos , Ácidos Tri-Iodobenzoicos/economia , Estados UnidosRESUMO
BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) is defined as a deterioration in renal function after administration of radiologic iodinated contrast media (CM). Iodixanol, showed a lower CI-AKI incidence than low-osmolar contrast media (LOCM). A cost-effectiveness analysis was performed comparing iodixanol and LOCM in intravenous (IV) setting in Italy. METHODS: A Markov model was developed. Patients moved across four health states: CI-AKI free, CI-AKI, myocardial infarction, and death. The simulation horizon was lifetime with 1-month cycles. Costs and outcomes were discounted at 3.5 percent rate. CI-AKI incidence was considered from published literature across different definitions. Cost-effectiveness of iodixanol was assessed in terms of incremental cost per life-year gained. Net monetary benefit (NMB) was also calculated. Both deterministic and probabilistic sensitivity analyses were performed. RESULTS: Base-case results showed an average survival increase of 0.51 life-years and a savings of 7.25 for iodixanol versus LOCM. The cost-effectiveness of iodixanol was confirmed when other scenarios were explored, such as varying CI-AKI definition, sub-populations with specified risk factors, CM hospital bids prices, and inclusion of adverse drug reactions of allergic nature. An NMB ranging between 6,007.25 and 30,007.25 was calculated. CONCLUSION: Base-case results show that IV iodixanol is cost-effective compared with LOCM in the Italian clinical setting of a hospital computed tomography radiology practice. However, some caution is due, mainly linked to inherent limitations of the modeling technique and to the lack of agreement on CI-AKI incidence data in the clinical literature.
Assuntos
Meios de Contraste/economia , Nefropatias/induzido quimicamente , Modelos Econômicos , Ácidos Tri-Iodobenzoicos/economia , Idoso , Qualidade de Produtos para o Consumidor , Meios de Contraste/efeitos adversos , Análise Custo-Benefício , Feminino , Humanos , Infusões Intravenosas , Injeções Intravenosas , Itália , Nefropatias/mortalidade , Masculino , Cadeias de Markov , Concentração Osmolar , Medição de Risco , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento , Ácidos Tri-Iodobenzoicos/efeitos adversosRESUMO
INTRODUCTION: 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. MATERIALS AND 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. CONCLUSION: 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.
Assuntos
Injúria Renal Aguda/induzido quimicamente , Meios de Contraste/economia , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/prevenção & controle , Injúria Renal Aguda/terapia , Idoso , Colômbia/epidemiologia , Meios de Contraste/efeitos adversos , Meios de Contraste/química , Análise Custo-Benefício , Árvores de Decisões , Custos de Medicamentos/estatística & dados numéricos , Feminino , Gastos em Saúde , Hospitalização/economia , Humanos , Reembolso de Seguro de Saúde/economia , Iohexol/efeitos adversos , Iohexol/análogos & derivados , Iohexol/química , Iohexol/economia , Iopamidol/efeitos adversos , Iopamidol/química , Iopamidol/economia , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Concentração Osmolar , Pacientes Ambulatoriais , Diálise Renal/economia , Diálise Renal/estatística & dados numéricos , Risco , Ácidos Tri-Iodobenzoicos/efeitos adversos , Ácidos Tri-Iodobenzoicos/química , Ácidos Tri-Iodobenzoicos/economiaRESUMO
Introduction. 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. Materials and 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. Conclusion. 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.
Introducción. Los medios de contraste pueden provocar falla renal aguda por toxicidad directa sobre las células tubulares e isquemia medular renal. Los pacientes diabéticos y los hospitalizados presentan mayor riesgo de desarrollar nefropatía inducida por medios de contraste que la población general. Objetivo. Establecer el costo-efectividad de los medios de contraste isosmolales e hiposmolales en pacientes con alto riesgo. Materiales and métodos. El análisis se basó en una revisión sistemática de la literatura científica, comparando los efectos nefrotóxicos de los medios isosmolales e hipoosmolales. Se consideraron sólo los costos directos, obtenidos del manual tarifario. Se calcularon las tasas del incremento del costo-efectividad, las curvas de eficiencia y de aceptabilidad. Se hicieron análisis univariados de sensibilidad para costos y efectos, así como probabilísticos. Se aplicaron tasas de descuento de 0 y 3 % a los resultados. Se usó como umbral de costo-efectividad por año de vida ganado, el producto interno bruto per cápita. Resultados. Las alternativas con Iopamidol y Iodixanol dominan a las demás porque reducen el riesgo de nefropatía inducida por contraste a un menor costo. La razón del incremento del costo-efectividad del iodixanol comparado con el iopamidol es de US$ 14.660 por año de vida ganado que más que duplica el umbral. Conclusión. El medio de baja osmolalidad, iopamidol, parece ser costo-efectivo comparado con iohexol u otros medios hiposmolares (iopromide, iobitridol, iomeprol, iopentol y ioxilan), en pacientes con alto riesgo de nefropatía inducida por contraste. La elección del medio hiposmolar, depende de la disponibilidad a pagar o del costo por ampolleta.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Injúria Renal Aguda/induzido quimicamente , Meios de Contraste/economia , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/prevenção & controle , Injúria Renal Aguda/terapia , Análise Custo-Benefício , Colômbia/epidemiologia , Meios de Contraste/efeitos adversos , Meios de Contraste/química , Árvores de Decisões , Custos de Medicamentos/estatística & dados numéricos , Gastos em Saúde , Hospitalização/economia , Reembolso de Seguro de Saúde/economia , Iohexol/efeitos adversos , Iohexol/análogos & derivados , Iohexol/química , Iohexol/economia , Iopamidol/efeitos adversos , Iopamidol/química , Iopamidol/economia , Tempo de Internação/economia , Programas Nacionais de Saúde/economia , Concentração Osmolar , Pacientes Ambulatoriais , Risco , Diálise Renal/economia , Diálise Renal , Ácidos Tri-Iodobenzoicos/efeitos adversos , Ácidos Tri-Iodobenzoicos/química , Ácidos Tri-Iodobenzoicos/economiaRESUMO
BACKGROUND: The increasing number of endovascular procedures made aware of a kidney disease induced by contrast media (CM). Contrast-induced nephropathy (=âCIN) can develop in 0.6-44â% of the treated patients by angiography andâ/âor endovascular intervention. The incidence in high-risk patients ranges from 50 to 70â%. In most cases CIN is inconspicuous and reversible. But pre-existing chronic kidney disease, diabetes mellitus, age and variable different risk factors (e.âg., PAOD) can induce irreversible renal impairment. The purpose of the presented trial is to investigate incidence, predictors, and out-come of CIN in chronic renal failure patients using two different CM; one non-ionic isoosmolar -iodixanol and the other non-ionic low-osmolar iopromide. METHODS: To evaluate the incidence of CIN after endovascular diagnostics and intervention two collectives of 100â patients with chronic renal insufficiency were treated with different contrast media (CM). Inclusion followed prospectively in two collectives. One collective received iopromide (Ultravist™, Bayer Health Care, Lever-kusen, Germany), and the second hundred patients received iodixanol (Visipaque™, Nycomed Amersham, Princeton, New Jersey). Demographics, comorbidities, procedure-related data were completed by serum creatinine levels and GFR (=âglomerular filtration rate). Inclusion criteria were a serum creatinine level ≥â1.5âmg% and a GFR ≤â60âmLâ/âmin. Those parameters were measured twice pre-interventionally, and one time 48-72 âhours after the endovascular procedure. RESULTS: Collectives were homogenous and comparable concerning pre-existing risk factors, age and gender. Renal function stayed at a constant level and was independent of contrast medium selection, repectively. Average creatinine levels ranged around 1.77âmg%â±â0.75 âstandard deviation (SD) pre-interventionally; postinterventional measurement exposed a creatinine level of 1.74âmg%â±â0.74âSD as mean of both collectives. GFR (preinterventional 39.64âmLâ/âminâ±â12.48âSD) increased non-significantly to 45.48âmLâ/âminâ±â16.82âSD. Pre-existing chronic kidney disease had no effect on renal function parameters; no other risk factors could be evaluated. CONCLUSION: According to cost-effectiveness a low-osmolar monomeric contrast medium (LOCM) is a sufficient selection, under careful renal function control.
Assuntos
Angiografia , Angioplastia com Balão , Meios de Contraste/toxicidade , Iohexol/análogos & derivados , Nefropatias/induzido quimicamente , Nefropatias/prevenção & controle , Falência Renal Crônica/diagnóstico por imagem , Falência Renal Crônica/terapia , Testes de Função Renal , Obstrução da Artéria Renal/diagnóstico por imagem , Obstrução da Artéria Renal/terapia , Ácidos Tri-Iodobenzoicos/toxicidade , Idoso , Idoso de 80 Anos ou mais , Angiografia/economia , Angioplastia com Balão/economia , Meios de Contraste/administração & dosagem , Meios de Contraste/economia , Análise Custo-Benefício , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Iohexol/economia , Iohexol/toxicidade , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Ácidos Tri-Iodobenzoicos/economiaRESUMO
PURPOSE: Many patients dislike oral contrast media due to their bad taste. The aim of the present study was to identify a solution that tastes better while providing the same opacification in order to offer oncological patients an alternative to the routinely used bad tasting oral contrast media. MATERIALS AND METHODS: In a single blinded, prospective clinical study, the orally administered intravenous contrast media iohexol (Omnipaque), iopromide (Ultravist), and iotrolan (Isovist) as well as the oral contrast media sodium amidotrizoate (Gastrografin) and ioxithalamate (Telebrix) were each compared to the oral contrast medium lysine amidotrizoate as the reference standard at a constant dilution. The density values of all contrast media with the same dilutions were first measured in a phantom study. The patient study included 160 patients who had undergone a prior abdominal CT scan with lysine amidotrizoate within 6 months. The patients rated their subjective taste impression on a scale of 0 (very bad) to 10 (excellent). In addition, adverse events and opacification were recorded and prices were compared. RESULTS: The phantom study revealed identical density values. Patients assigned much higher taste impression scores of 8 and 7 to iohexol and iotrolan, respectively, as compared to a score of 3 for the conventional lysine amidotrizoate (p< 0.05). Iopromide and sodium amidotrizoate did not differ significantly from lysine amidotrizoate. The opacification of all contrast media and experienced adverse events did not differ significantly. Iotrolan (ca. 120 euro/100 ml), Iohexol and Iopromide (ca. 70 euro/100 ml) are more expensive than the conventional oral contrast media (ca. 10 - 20 euro/100 ml). CONCLUSION: Orally administered solutions of non-ionic contrast media improve patient comfort due to the better taste and provide the same opacification in comparison to conventional oral contrast media. At present, their use should be limited to individual cases due to the higher costs.
Assuntos
Meios de Contraste/administração & dosagem , Meios de Contraste/economia , Iohexol/administração & dosagem , Iohexol/economia , Radiografia Abdominal , Paladar , Tomografia Computadorizada por Raios X , Ácidos Tri-Iodobenzoicos/administração & dosagem , Ácidos Tri-Iodobenzoicos/economia , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Interpretação Estatística de Dados , Diatrizoato de Meglumina/administração & dosagem , Diatrizoato de Meglumina/economia , Feminino , Humanos , Injeções Intravenosas , Intestino Delgado/diagnóstico por imagem , Iohexol/análogos & derivados , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Imagens de Fantasmas , Estudos Prospectivos , Padrões de ReferênciaRESUMO
BACKGROUND: Acute renal failure after contrast-induced nephropathy is a clinically important and costly complication after the use of iodine-based contrast media. We investigated the cost and cost-effectiveness of 2 contrast media in patients at high risk of contrast-induced nephropathy. METHODS: The analyses were based on a randomized, prospective, multinational clinical study comparing the nephrotoxic effects of an isosmolar nonionic contrast medium, iodixanol, with those of a low-osmolar nonionic contrast medium, iohexol. Resource utilization data were obtained from the study and from a retrospective review of patients' hospital records. Swedish, German, and French unit prices were applied to resources used. Between-group differences in average costs were analyzed using a nonparametric bootstrap method. RESULTS: Resource utilization data for 125 patients were analyzed. Seven contrast media-related serious adverse reactions, of which 6 were acute renal failures, were noted in 6 patients receiving iohexol. Two patients in the iodixanol group had 1 nonserious reaction each. The mean hospitalization cost per patient was Euros 489, Euros 573, and Euros 393 lower after iodixanol than after iohexol using Swedish, German, and French unit prices, respectively. The mean per-patient costs of treating adverse drug reactions were Euros 371, Euros 399, and Euros 445 lower after iodixanol than after iohexol, using the respective unit prices (P < or = 0.01). Iodixanol was cost-effective compared with iohexol, with both lower costs and better effects related to fewer adverse drug reactions. CONCLUSIONS: The isosmolar contrast medium iodixanol appears to be cost-effective when compared with a low-osmolar contrast medium, iohexol, in diabetic patients with renal impairment undergoing angiography.
Assuntos
Angiografia/economia , Meios de Contraste/economia , Iohexol/economia , Ácidos Tri-Iodobenzoicos/economia , Injúria Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Angiografia Coronária/economia , Análise Custo-Benefício , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Custos Hospitalares , Humanos , Iohexol/efeitos adversos , Nefropatias/complicações , Estudos Prospectivos , Fatores de Risco , Ácidos Tri-Iodobenzoicos/efeitos adversosRESUMO
The goal of this study was to quantitatively evaluate the CT enhancement characteristics of selected intracranial blood vessels using four different volumes of a contrast medium under otherwise identical conditions in order to help determine a cost-effective dose. In a double blind, prospective manner, 100 patients referred for contrast-enhanced cranial CT were randomly assigned to receive one of four different volumes (50, 75, 100 or 120 ml) of ioversol 320 mg I/ml which was subsequently administered intravenously at a rate of 1 ml/s via a power injector. Unenhanced images were also obtained. Scanning times, slice thickness and other parameters were identical in all patients. Scanning was initiated immediately following delivery of the full volume of contrast. Region of interest Hounsfield unit measurements were acquired in a standardized manner using a 1 mm diameter circle on the pre- and post-contrast scans of the supraclinoid left internal carotid artery (LICA), supraclinoid right internal carotid artery (RICA), basilar artery (BA), and torcular region (TR). The mean enhancement value (in Hounsfield units) for the 50 ml, 75 ml, 100 ml and 120 ml dose groups respectively were as follows for each vessel: LICA 29.9, 41.5, 63.9, 64.6; RICA 30.1, 39.4, 62.6, 65.1; BA 30.0, 41.7, 66.0, 71.9; TR 31.7, 46.8, 68.9, 74.3. There was no statistically significant (p > 0.05) difference in enhancement in any of the four vessels when the 120 ml volume was delivered compared to the 100 ml volume. However, there was a statistically significant (p < 0.05) improvement in enhancement in all four vessels when 100 ml of contrast was administered compared to 75 ml.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Tomografia Computadorizada por Raios X , Ácidos Tri-Iodobenzoicos/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Basilar/diagnóstico por imagem , Artéria Carótida Interna/diagnóstico por imagem , Artérias Cerebrais/diagnóstico por imagem , Meios de Contraste/economia , Análise Custo-Benefício , Método Duplo-Cego , Feminino , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Intensificação de Imagem Radiográfica , Ácidos Tri-Iodobenzoicos/economiaRESUMO
OBJECTIVE: To determine the efficacy of two concentrations of nonionic contrast medium (320 and 240 mg iodine/mL; Optiray [ioversol], Mallinckrodt Medical) for enhanced dynamic computed tomography (CT) of the neck. PATIENTS AND METHODS: Between March 1992 and August 1993, 50 patients undergoing dynamic CT of the neck were assigned randomly to receive either the higher-strength or the lower-strength contrast agent. The amount of opacification was measured objectively, and the quality of the scans was assessed subjectively by two radiologists without knowledge of which contrast agent had been administered. Both immediate and delayed side effects were recorded. RESULTS: The higher-strength contrast medium gave greater opacification (p = 0.0006, t-test), but both concentrations yielded images of excellent quality (p = 0.125, chi 2 test). The number of patients affected by immediate minor complications was lower with Optiray 240 (11 [44%]) than with Optiray 320 (23 [92%]) (p < 0.001, chi 2 test). The number of patients affected by delayed side effects was similar in the two groups (7 [28%] with Optiray 240 and 9 [36%] with Optiray 320; p > 0.70, chi 2 test). No predictive relation between immediate and delayed complications was observed. CONCLUSIONS: Because adequate contrast can be obtained with the lower-strength contrast medium, it can be used in dynamic CT of the neck as a means of reducing the cost and the side effects associated with such imaging.