RESUMO
AIM: To map current contrast-enhanced computed tomography (CT) pathways, develop a risk-stratified pathway, and model associated costs and resource use. MATERIALS AND METHODS: Phase 1 comprised multicentre mapping of current practice and development of an alternative pathway, replacing pre-assessment of estimated glomerular filtration rate (eGFR) with a scan-day screening questionnaire for risk stratification and point of care (PoC) creatinine. Phase 2 measured resource use and analysis of routinely collected data, used to populate a model comparing the costs of current and risk-stratified pathways in Phase 3. RESULTS: Site variation across a range of processes within the clinical care pathway was identified. Data from a single centre suggested that 78% (n=347/447) could have avoided their pre-scan laboratory test as they did not have post-contrast acute kidney injury (AKI) risk factors. Only 24% of outpatients who underwent computed tomography (CT) would have identified risk factors, which would have prompted a scan-day PoC test. There was a 94% probability that the risk-stratified pathway was cost-saving, with an estimated 5-year potential cost saving of £69,620 (95% CI: -£13,295-£154,603). Although the cost of a laboratory serum creatinine test is cheaper than the PoC equivalent (£5.29 versus £5.96), the screening questionnaire ruled out the need for a large majority of the eGFR measurements specifically for the CT examination. CONCLUSION: The present study proposes an alternative pathway, which has the potential to improve the efficiency of the current CT pathway. A multicentre appraisal is required to demonstrate the impact of embedding this new pathway on a wider NHS level, particularly in light of new diagnostic guidance (DG37) published by NICE.
Assuntos
Meios de Contraste/efeitos adversos , Meios de Contraste/economia , Custos e Análise de Custo/métodos , Testes de Função Renal/métodos , Intensificação de Imagem Radiográfica/métodos , Tomografia Computadorizada por Raios X/métodos , Meios de Contraste/administração & dosagem , Custos e Análise de Custo/estatística & dados numéricos , Taxa de Filtração Glomerular , Humanos , Rim/diagnóstico por imagem , Medicina de Precisão/métodos , Intensificação de Imagem Radiográfica/economia , Medição de Risco , Fatores de RiscoRESUMO
RESEARCH QUESTION: What are the long-term costs and effects of oil- versus water-based contrast in infertile women undergoing hysterosalpingography (HSG)? DESIGN: This economic evaluation of a long-term follow-up of a multicentre randomized controlled trial involved 1119 infertile women randomized to HSG with oil- (nâ¯=â¯557) or water-based contrast (nâ¯=â¯562) in the Netherlands. RESULTS: In the oil-based contrast group, 39.8% of women needed no other treatment, 34.6% underwent intrauterine insemination (IUI) and 25.6% had IVF/intracytoplasmic sperm injection (ICSI) in the 5 years following HSG. In the water-based contrast group, 35.0% of women had no other treatment, 34.2% had IUI and 30.8% had IVF/ICSI in the 5 years following HSG (Pâ¯=â¯0.113). After 5 years of follow-up, HSG using oil-based contrast resulted in equivalent costs (mean cost difference -144; 95% confidence interval [CI] -579 to +290; Pâ¯=â¯0.515) for a 5% increase in the cumulative ongoing pregnancy rate compared with HSG using water-based contrast (80% compared with 75%, Relative Risk (RR) 1.07; 95% CI 1.00-1.14). Similarly, HSG with oil-based contrast resulted in equivalent costs (mean cost difference -50; 95% CI -576 to +475; Pâ¯=â¯0.850) for a 7.5% increase in the cumulative live birth rate compared with HSG with water-based contrast (74.8% compared with 67.3%, RR 1.11; 95% CI 1.03-1.20), making it the dominant strategy. Scenario analyses suggest that the oil-based contrast medium is the dominant strategy up to a price difference of 300. CONCLUSION: Over a 5-year follow-up, HSG with an oil-based contrast was associated with a 5% increase in ongoing pregnancy rate, a 7.5% increase in live birth rate and similar costs to HSG with water-based contrast.
Assuntos
Meios de Contraste/economia , Óleo Etiodado/economia , Histerossalpingografia/economia , Ácido Iotalâmico/análogos & derivados , Análise Custo-Benefício , Feminino , Seguimentos , Humanos , Histerossalpingografia/estatística & dados numéricos , Ácido Iotalâmico/economia , Gravidez , Taxa de Gravidez , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Percutaneous nephrolithotomy (PCNL) is a standard procedure for large renal stones. Contrast (traditionally) as well as air is being used to delineate pelvi-calyceal system (PCS) to perform initial puncture. Contrast, when used has certain disadvantages including poor differentiation of anterior and posterior calyces. In this interim analysis of 122 patients of a prospective study subjects were stratified in two groups: in group 1, contrast was used while in group 2, air was used to delineate PCS. Out of 122,103 patients underwent puncture by contrast or air exclusively while 19 patients required mix of contrast and air (14 patients failed puncture using contrast while 5 using air). Mean dosage of radiation exposure (8.43 vs. 14.26 mGy), duration of radiation exposure (0.66 vs. 1.02 min), access time (3.72 vs. 5.84 min), were less in group 2 as compared to group 1. 84.5% of patients underwent puncture in single attempt in group 2 as compared to 56.25% in group 1. Five patients had post-operative fever and one had trans-pleural tract dilation. Complete stone clearance was seen in 94.8% of patients using air to only 75% of patients using contrast. Conclusion: Air pyelogram is a feasible, safe, cost effective and efficient access alternative to contrast pyelogram and in difficult situation a mixture of both is better than using one.
Assuntos
Cálculos Renais/cirurgia , Cálices Renais/diagnóstico por imagem , Nefrolitotomia Percutânea/métodos , Punções/métodos , Urografia/métodos , Adulto , Ar , Meios de Contraste/administração & dosagem , Meios de Contraste/efeitos adversos , Meios de Contraste/economia , Estudos de Viabilidade , Feminino , Humanos , Cálices Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Urografia/efeitos adversos , Urografia/economia , Adulto JovemAssuntos
Meios de Contraste , Programas Nacionais de Saúde/legislação & jurisprudência , Prescrições , Radiologia/legislação & jurisprudência , Mecanismo de Reembolso/legislação & jurisprudência , Meios de Contraste/economia , Alemanha , Humanos , Programas Nacionais de Saúde/economia , Prescrições/economia , Radiologia/economiaRESUMO
OBJECTIVE. Utilization and waste in diagnostic imaging have substantially increased worldwide. The purpose of this study was to highlight the utilization of contrast material and cost savings resulting from implementation of a multidose bulk IV contrast delivery system. MATERIALS AND METHODS. An observational study was conducted in October-November 2018 in eight hospitals in eight provinces in China. Contrast media specifications were 100-mL single-use IV contrast vials and 200-mL and 500-mL bulk packaging. Linear regression analysis was performed to identify the factors influencing contrast media use. Cost-minimization and sensitivity analyses were performed from patient and payer perspectives. RESULTS. A total of 1032 patients, some of whom underwent more than one CT examination, were enrolled in this study (100-mL package, 776 CT examinations; 200-mL package, 382 CT examinations). The mean injected volume of contrast medium was 75.46 mL. Number of scanned body parts, specification of amount of contrast medium (0, 100 mL; 1, 200 mL), whether the examination was CT angiography (CTA) (0, not CTA; 1, CTA), and patient weight all had a positive impact on the injected volume of contrast medium (p < 0.001 for all variables). Implementation of a multidose bulk IV contrast delivery system combined with different reimbursement units resulted in substantial waste reduction, estimated at US$5.59-6.04 per contrast-enhanced CT examination from the payer perspective, US$12.84-14.66 per examination from the patient perspective, and a total reduction of US$18.29-20.70 per examination. CONCLUSION. Use of multidose packaging of contrast media combined with reimbursement units for patients undergoing IV contrast-enhanced CT was found to be cost saving compared with use of single-dose packaging.
Assuntos
Meios de Contraste/administração & dosagem , Meios de Contraste/economia , Redução de Custos , Embalagem de Medicamentos , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China , Árvores de Decisões , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: Guidelines on safe use of iodinated contrast material recommend intravenous prophylactic hydration to prevent post-contrast adverse (renal) effects. Recently, guidelines have been updated and standard prophylaxis is no longer recommended for the majority of patients. The current study aims to evaluate the consequences for clinical practice of the updated guidelines in terms of complications, hospitalisations, and costs. METHODS: The Contrast-Induced Nephropathy After Reduction of the prophylaxis Threshold (CINART) project is a retrospective observational study. All elective procedures with intravascular iodinated contrast administration at Maastricht University Medical Centre (UMC+) in patients aged > 18 years, formerly eligible for prophylaxis (eGFR 30-44 ml/min/1.73 m2 or eGFR 45-59 ml/min/1.73 m2 in combination with diabetes or > 1 predefined risk factor), and currently eligible for prophylaxis (eGFR < 30 ml/min/1.73 m2) were included. Data were used to calculate relative reductions in complications, hospitalisations, and costs associated with standard prophylactic intravenous hydration. CINART is registered with Clinicaltrials.gov: NCT03227835. RESULTS: Between July 1, 2017, and July 1, 2018, 1992 elective procedures with intravascular iodinated contrast in patients formerly and currently eligible for prophylaxis were identified: 1808 in patients formerly eligible for prophylaxis and 184 in patients currently eligible for prophylaxis. At Maastricht UMC+, guideline updates led to large relative reductions in numbers of complications of prophylaxis (e.g. symptomatic heart failure; - 89%), extra hospitalisations (- 93%), and costs (- 91%). CONCLUSION: Guideline updates have had a demonstrable impact on daily clinical practice benefiting patient, hospital, and health care budgets. Clinical practice varies between institutions and countries; therefore, a local estimation model is provided with which local impact on costs, hospitalisations, and complications can be calculated. KEY POINTS: ⢠Clinical practice guidelines recommend prophylactic intravenous hydration to prevent post-contrast adverse outcomes such as contrast-induced acute kidney injury. ⢠Clinical practice guidelines have recently been updated, and standard prophylaxis is no longer recommended for the majority of patients. ⢠The guideline updates have a large impact on daily clinical practice: relative reductions at Maastricht UMC+ were - 89% prophylaxis complications, - 93% hospitalisations, and - 91% costs, and similar reductions are expected for Dutch and adherent European medical centres.
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Meios de Contraste/administração & dosagem , Meios de Contraste/efeitos adversos , Radioisótopos do Iodo/administração & dosagem , Radioisótopos do Iodo/efeitos adversos , Guias de Prática Clínica como Assunto , Injúria Renal Aguda/induzido quimicamente , Administração Intravenosa , Adolescente , Adulto , Idoso , Meios de Contraste/economia , Hidratação/economia , Hidratação/métodos , Taxa de Filtração Glomerular , Custos Hospitalares , Hospitalização/economia , Humanos , Radioisótopos do Iodo/economia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
Cardiac MR (CMR) is increasingly used to assess for cardiac involvement in patients with Duchenne muscular dystrophy (DMD). The frequent use of gadolinium based contrast agents (GBCAs) has been called into question with reports of intracranial gadolinium deposition in patients receiving multiple administrations. We adopted a conservative GBCA administration policy, limiting the frequency of GBCA exposure in patients with previously documented late gadolinium enhancement. The aim of our study was to evaluate the clinical effects of this policy change. Data were retrospectively reviewed on 405 consecutive patients with DMD who underwent CMR evaluation. Patients were grouped into conservative GBCA administration or historical control. CMR reports were evaluated and clinical reports were reviewed to determine actionable changes. Ohio Medicaid reimbursements were used to estimate costs. A total of 187 patients comprised the conservative GBCA group and 218 patients the historical cohort. The conservative GBCA group had lower contrast administration rates (84% vs. 99%, p < 0.0001), shorter scan times (35.2 vs. 39.0 min, p < 0.0001), and lower estimated medical costs ($339 vs. $351/study). There was no change regarding the initial presence of first-time late gadolinium enhancement, and no difference in actionable change. Contrast administration substantially decreased 7 months post-policy change (65%) compared to the initial 7 months (96%, p < 0.0001). In the current era with unclear concern for intracranial gadolinium deposition, thoughtful GBCA administration is warranted in patients anticipated to undergo multiple CMRs. Our updated approach has resulted in fewer patients receiving contrast, shorter scan times, and less medical costs, without appreciable changes to patient management.
Assuntos
Cardiomiopatias/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Imagem Cinética por Ressonância Magnética , Meglumina/administração & dosagem , Distrofia Muscular de Duchenne/complicações , Compostos Organometálicos/administração & dosagem , Adolescente , Cardiomiopatias/economia , Cardiomiopatias/etiologia , Criança , Meios de Contraste/economia , Redução de Custos , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Humanos , Imagem Cinética por Ressonância Magnética/economia , Masculino , Meglumina/economia , Distrofia Muscular de Duchenne/diagnóstico , Distrofia Muscular de Duchenne/economia , Compostos Organometálicos/economia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo , Fluxo de TrabalhoRESUMO
INTRODUCTION: Vertigo and dizziness are symptoms with a significant burden in the hospital and involve several specialties. There are few guidelines of radiological tests for these symptoms. AIMS: To know which profile of patients with vertigo and dizziness has neuroimaging tests, quantify and describe the radiological findings. To analyze the cost-utility of CT and MRI in the study of these patients. PATIENTS AND METHODS: Descriptive study, we selected patients referred to the hospital for vertigo and dizziness. We analyze demographic and clinical characteristics and quantify the neuroimaging tests requested. We describe the radiological findings, assess their relevance in the diagnosis and detail the cost-benefit. RESULTS: We identified 493 patients, those with neuroimaging test (60%) are older, depressed and frequented the emergency department because of vertigo. The most requested test was the cranial CT scan (5% identifies the cause of the symptom). MRI of the inner ear and cerebellopontine angle was the test that presented the most significant findings (17.7%). The 286 image tests requested for vertigo cost 56,741 euros. The cost for a positive test was 1,576 euros. CONCLUSIONS: A large number of head CT and MRI are made in patients with vertigo and dizziness. A clinical suspicion is recommended from the anamnesis and exploration to make a good selection of test to request. In more than 90% of cases, radiological findings are not shown in relation to vertigo.
TITLE: Que aporta la neuroimagen en pacientes con vertigo y mareo? Analisis coste-utilidad.Introduccion. Vertigo y mareo son sintomas que suponen una carga significativa en el hospital e involucran a varias especialidades. Existen pocas guias sobre la solicitud de pruebas radiologicas ante estos sintomas. Objetivos. Conocer que perfil de pacientes con vertigo y mareo tiene realizadas pruebas de neuroimagen, cuantificar y describir los hallazgos radiologicos, y analizar el coste-utilidad de la tomografia computarizada (TC) y la resonancia magnetica (RM) en pacientes con estos sintomas. Pacientes y metodos. Estudio descriptivo en el que se seleccionan pacientes remitidos al hospital por vertigo y mareo. Se analizan caracteristicas demograficas y clinicas y se cuantifican las pruebas de neuroimagen solicitadas. Se describen los hallazgos radiologicos, se valora su relevancia en el diagnostico y se detalla el coste. Resultados. Se identifica a 493 pacientes, el 60% tiene realizada una prueba de neuroimagen; son pacientes de mas edad, depresivos y que han acudido a urgencias por vertigo. La prueba mas realizada fue la TC de craneo sin contraste (el 5% identifica la causa del sintoma). La que presento mas hallazgos significativos fue la RM de la base del craneo (17,7%). Las 286 pruebas de imagen solicitadas por vertigo costaron 56.741 euros. El gasto para obtener un diagnostico radiologico fue de 1.576 euros. Conclusiones. Se realiza un gran numero de TC y RM de cabeza en pacientes con vertigo y mareo. Es recomendable tener un diagnostico de sospecha previo a partir de la anamnesis y la exploracion para hacer una buena seleccion de las pruebas que hay que solicitar. En mas del 90% de los casos no se muestran hallazgos radiologicos en relacion con el vertigo.
Assuntos
Tontura/diagnóstico por imagem , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Vertigem/diagnóstico por imagem , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Meios de Contraste/economia , Análise Custo-Benefício , Diagnóstico Diferencial , Tontura/economia , Tontura/etiologia , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Imageamento por Ressonância Magnética/economia , Masculino , Pessoa de Meia-Idade , Neuroimagem/economia , Neuroimagem/métodos , Osso Petroso/diagnóstico por imagem , Utilização de Procedimentos e Técnicas/economia , Estudos Retrospectivos , Base do Crânio/diagnóstico por imagem , Espanha , Tomografia Computadorizada por Raios X/economia , Procedimentos Desnecessários/economia , Vertigem/economia , Vertigem/etiologiaAssuntos
Injúria Renal Aguda/economia , Injúria Renal Aguda/prevenção & controle , Meios de Contraste/efeitos adversos , Meios de Contraste/economia , Medicina Baseada em Evidências/economia , Custos Hospitalares , Assistência Centrada no Paciente/economia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/economia , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/epidemiologia , Idoso , Meios de Contraste/administração & dosagem , Redução de Custos , Análise Custo-Benefício , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Missouri/epidemiologia , Avaliação de Programas e Projetos de Saúde , Fatores de Proteção , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
OBJECTIVE: To assess the impact of shifting arthrogram injectate compounding from the fluoroscopy suite to the main hospital sterile pharmacy on cost, examination delays, and infection rates. MATERIALS AND METHODS: All arthrograms from the 12 months before (629 in total) and the 12 months after (699 in total) the change in arthrogram preparation procedure were compared to identify differences in examination delays and infection rate. The arthrogram formulation was sent to the Compounder's International Analytical Laboratory for stability testing. Finally, cost per injection analysis was performed to compare fluoroscopy suite with sterile pharmacy compounding. RESULTS: In the 699 arthrograms performed in the 12 months following transfer of arthrogram preparation to the main hospital pharmacy, there were 0 reported examination delays, 0 reported infections, and a 53% decrease in the material cost per arthrogram. There were three recorded instances of fluoroscopy suite preparation of arthrogram injectate due to unexpected add-on patients. Outside stability testing determined that the arthrogram injectate retained at least 90% potency 30 h post-preparation. CONCLUSION: Shifting the compounding of the arthrogram injectate from the fluoroscopy room to the main hospital sterile pharmacy provides a modest cost saving and can be accomplished without examination delays or any increase in infection rate. It brought our practice into compliance with USP797, which is the current guideline for compounding practitioners, by transferring the compounding preparation of the arthrogram injectate from a procedure room to the sterile pharmacy.
Assuntos
Meios de Contraste/química , Composição de Medicamentos/normas , Gadolínio DTPA/química , Iopamidol/química , Imageamento por Ressonância Magnética , Serviço de Farmácia Hospitalar/normas , Meios de Contraste/economia , Redução de Custos , Composição de Medicamentos/economia , Fluoroscopia , Gadolínio DTPA/economia , Fidelidade a Diretrizes , Humanos , Iopamidol/economia , Serviço de Farmácia Hospitalar/economiaRESUMO
BACKGROUND/PURPOSE: We examined outcomes before and after implementing an enteral water-soluble contrast protocol for management of pediatric adhesive small bowel obstruction (ASBO). METHODS: Medical records were reviewed retrospectively for all children admitted with ASBO between November 2010 and June 2017. Those admitted between November 2010 and October 2013 received nasogastric decompression with decision for surgery determined by surgeon judgment (preprotocol). Patients admitted after October 2013 (postprotocol) received water-soluble contrast early after admission, were monitored with serial examinations and radiographs, and underwent surgery if contrast was not visualized in the cecum by 24â¯h. Group outcomes were compared. RESULTS: Twenty-six patients experienced 29 admissions preprotocol, and 11 patients experienced 12 admissions postprotocol. Thirteen (45%) patients admitted preprotocol underwent surgery, versus 2 (17%) postprotocol patients (pâ¯=â¯0.04). Contrast study diagnostic sensitivity as a predictor for ASBO resolution was 100%, with 90% specificity. Median overall hospital LOS trended shorter in the postprotocol group, though was not statistically significant (6.2â¯days (preprotocol) vs 3.6â¯days (postprotocol) pâ¯=â¯0.12). Pre- vs. postprotocol net operating cost per admission yielded a savings of $8885.42. CONCLUSIONS: Administration of water-soluble contrast after hospitalization for pediatric ASBO may play a dual diagnostic and therapeutic role in management with decreases in surgical intervention, LOS, and cost. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: Level III.
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Meios de Contraste/uso terapêutico , Diatrizoato de Meglumina/uso terapêutico , Obstrução Intestinal/terapia , Aderências Teciduais/terapia , Adolescente , Criança , Pré-Escolar , Meios de Contraste/economia , Diatrizoato de Meglumina/economia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização , Humanos , Lactente , Obstrução Intestinal/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/efeitos dos fármacos , Intestino Delgado/patologia , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Aderências Teciduais/complicações , Aderências Teciduais/diagnóstico por imagem , Adulto JovemRESUMO
PURPOSE: To quantify the monetary and time costs associated with oral contrast administration in the emergency department (ED) for patients with nontraumatic abdominal pain and to evaluate the cost savings associated with an institutional policy change in the criteria for oral contrast administration. METHODS: A HIPAA-complaint, institutional review board-approved time-driven activity-based costing analysis was performed using both prospective time studies and retrospective data obtained from a quaternary care center. Retrospective data spanned a 1-year period (January 1, 2016, to December 31, 2016). A process map was generated. Examination volume-related data, labor costs, and material costs were determined and applied to a base-case model. Univariate and multivariate sensitivity analyses were conducted. Multivariate analysis was used to estimate the cost savings associated with a policy change eliminating oral contrast for patients with body mass index ≥ 25 kg/m2, no prior abdominal surgery within 30 days preceding CT, and no inflammatory bowel disease. RESULTS: The baseline oral contrast utilization rate was 86% (4,541 of 5,263). The annual base-case cost estimate for oral contrast administration was $82,552. In multivariate analyses, this ranged from $13,685 to $315,393. The model was most sensitive to the volume of CTs requiring oral contrast. Applying parameters from the new policy change reduced the annual cost by 52% (cost saving: $35,836.57). Impact of oral contrast on time to discharge was highly variable and dependent on the contrast agent utilized. CONCLUSION: Costs associated with oral contrast in the ED are modest and should be balanced with its potential diagnostic benefits. Our criteria reduced oral contrast utilization by 52%.
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Dor Abdominal/diagnóstico por imagem , Meios de Contraste/administração & dosagem , Meios de Contraste/economia , Serviço Hospitalar de Emergência/economia , Avaliação de Processos em Cuidados de Saúde , Radiografia Abdominal/economia , Administração Oral , Custos e Análise de Custo , Diagnóstico Diferencial , Humanos , Política Organizacional , Estudos Prospectivos , Estudos Retrospectivos , Estudos de Tempo e MovimentoRESUMO
Hepatic and renal lesions detected during ultrasound examinations frequently require subsequent contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) for characterization, delaying time to imaging diagnosis and increasing overall health care expenditures. Contrast-enhanced ultrasonography (CEUS) is a comparatively low-cost diagnostic tool that is underutilized in the evaluation of such indeterminate or suspicious hepatic and renal lesions. A retrospective chart review of CEUS examinations performed in our department demonstrated significantly shorter time to imaging diagnosis with CEUS compared to CT or MRI, largely due to the ability to perform the CEUS examination at the time of initial examination. For example mean time to completion for outpatient examinations was 5.2, 52.3, and 123.5 days for CEUS, CT, and MRI, respectively. The majority (78.4%) of CEUS examinations were completed the same day as the initial examination. Additionally, 66.7% of CEUS examinations were deemed diagnostic, abrogating further workup with CT or MRI in most cases. Annual imaging cost reduction of up to US $117,000 is anticipated in our institution based on projected reductions in follow-up CT and MRI examinations. These results indicate when CEUS was used as a first step to characterize both incidental lesions in patients without known risk factors for malignancy as well as suspicious lesions in patients with risk factors it can greatly reduce time to diagnosis and health care expenditures.
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Meios de Contraste/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Aumento da Imagem/métodos , Imageamento por Ressonância Magnética/economia , Tomografia Computadorizada por Raios X/economia , Ultrassonografia/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais de Condado , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Estados Unidos , Adulto JovemRESUMO
OBJECTIVE: To determine the cost effectiveness of the use of oil-based versus water-based contrast in infertile women undergoing hysterosalpingography (HSG). DESIGN: Economic evaluation alongside a multicenter randomized trial. SETTING: Hospitals. PATIENT(S): Infertile women with an ovulatory cycle, 18-39 years of age, low risk of tubal pathology. INTERVENTION(S): Use of oil-based versus water-based contrast during HSG. MAIN OUTCOME MEASURE(S): Costs per additional ongoing pregnancy and per live birth within 6 months of randomization, incremental cost-effective ratios (ICERs). RESULT(S): A total of 1,119 women were randomized to HSG (oil-based contrast, n = 557; water-based contrast, n = 562). After HSG, most women had no additional treatment; a minority had IUI or IVF. In the oil group, 39.7% women had an ongoing pregnancy within 6 months of randomization versus 29.1% women in the water group. There was a 10.7% increase in the live birth rate in the oil group. For ongoing pregnancy, the mean costs per couple were US$2,014 in the oil group and US$1,144 in the water group, with a corresponding ICER of US$8,198 per additional ongoing pregnancy. For live birth, the mean costs per couple were US$11,532 in the oil group and US$8,310 in the water group, with a corresponding ICER of US$30,112 per additional live birth. CONCLUSION(S): Hysterosalpingography with oil-based contrast results in higher 6-month ongoing pregnancy and live birth rate. If society is willing to pay US$8,198 for an additional ongoing pregnancy, HSG with oil-based contrast is a cost-effective strategy compared with HSG with water-based contrast for infertile, ovulatory women at low risk for tubal pathology. CLINICAL TRIAL REGISTRATION NUMBER: Dutch Trial Register, NTR 6577 (www.trialregister.nl).
Assuntos
Meios de Contraste/economia , Análise Custo-Benefício , Óleo Etiodado/economia , Histerossalpingografia/economia , Infertilidade Feminina/economia , Ácido Iotalâmico/análogos & derivados , Adolescente , Adulto , Meios de Contraste/administração & dosagem , Análise Custo-Benefício/métodos , Óleo Etiodado/administração & dosagem , Feminino , Humanos , Histerossalpingografia/métodos , Infertilidade Feminina/diagnóstico por imagem , Infertilidade Feminina/terapia , Ácido Iotalâmico/administração & dosagem , Ácido Iotalâmico/economia , Gravidez , Taxa de Gravidez/tendências , Água/administração & dosagem , Adulto JovemRESUMO
Contrast is a recommended but frequently unused tool in transthoracic echocardiography to improve detection of left ventricular thrombus in patients with ejection fraction (EF) ≤35%. The clinical and economic outcomes of a possible solution (i.e., universal contrast use) remain uncertain. To estimate clinical benefit, cost, and cost-effectiveness of a diagnostic strategy of universal use of contrast (vs no contrast) during echocardiography in patients with reduced EF, we created a decision analytic model using echocardiography sensitivity and specificity for left ventricular thrombus detection from a meta-analysis, as well as survival and cost estimates from published literature. Universal contrast use (vs nonuse) did not result in clinical or statistical improvement in estimated life years (8.509 vs 8.504) or quality-adjusted life years (5.620 vs 5.616). The cost of contrast was offset by reductions in subsequent health-care costs, resulting in similar total costs ($201,569 vs $201,573). In conclusion, although an intuitively attractive practice improvement strategy, universal contrast use strategy appears to offer no appreciable benefit to quality-adjusted survival or financial outcomes in patients with low EF.
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Meios de Contraste/economia , Ecocardiografia/economia , Custos de Cuidados de Saúde , Insuficiência Cardíaca/complicações , Ventrículos do Coração , Volume Sistólico/fisiologia , Trombose/diagnóstico , Meios de Contraste/farmacologia , Análise Custo-Benefício , Feminino , Cardiopatias/diagnóstico , Cardiopatias/economia , Cardiopatias/etiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Trombose/economia , Trombose/etiologia , Estados UnidosAssuntos
Cardiopatias/diagnóstico por imagem , Cardiopatias/economia , Preços Hospitalares/estatística & dados numéricos , Imageamento por Ressonância Magnética/economia , Programas Nacionais de Saúde/economia , Mecanismo de Reembolso/economia , Tomografia Computadorizada por Raios X/economia , Serviços Técnicos Hospitalares/economia , Meios de Contraste/economia , Current Procedural Terminology , Alemanha , Humanos , Oximetria/economiaRESUMO
INTRODUCTION: In many centres, a fixed method of contrast-media administration is used for CT regardless of patient body habitus. The aim of this trial was to assess contrast enhancement of the aorta, portal vein, liver and spleen during abdomino-pelvic CT imaging using a weight-adapted contrast media protocol compared to the current fixed dose method. METHODS: Thirty-nine oncology patients, who had previously undergone CT abdomino-pelvic imaging at the institution using a fixed contrast media dose, were prospectively imaged using a weight-adapted contrast media dose (1.4 ml/kg). The two sets of images were assessed for contrast enhancement levels (HU) at locations in the liver, aorta, portal vein and spleen during portal-venous enhancement phase. The t-test was used to compare the difference in results using a non-inferiority margin of 10 HU. RESULTS: When the contrast dose was tailored to patient weight, contrast enhancement levels were shown to be non-inferior to the fixed dose method (liver p < 0.001; portal vein p = 0.003; aorta p = 0.001; spleen p = 0.001). As a group, patients received a total contrast dose reduction of 165 ml using the weight-adapted method compared to the fixed dose method, with a mean cost per patient of £6.81 and £7.19 respectively. CONCLUSION: Using a weight-adapted method of contrast media administration was shown to be non-inferior to a fixed dose method of contrast media administration. Patients weighing 76 kg, or less, received a lower contrast dose which may have associated cost savings. A weight-adapted contrast media protocol should be implemented for portal-venous phase abdomino-pelvic CT for oncology patients with adequate renal function (>70 ml/min/1.73 m2).
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Abdome/diagnóstico por imagem , Peso Corporal , Meios de Contraste/administração & dosagem , Iohexol/administração & dosagem , Pelve/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta/diagnóstico por imagem , Meios de Contraste/economia , Redução de Custos , Estudos de Equivalência como Asunto , Feminino , Humanos , Iohexol/economia , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Estudos Prospectivos , Baço/diagnóstico por imagem , Tomografia Computadorizada por Raios X/economia , Adulto JovemRESUMO
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.
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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
OBJECTIVES: We evaluated the cost-effectiveness of a gadoxetic acid-enhanced MRI (EOB-MRI) strategy compared with conventional MRI strategy and biopsy to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA). METHODS: A decision tree model was constructed to compare the cost-effectiveness of EOB-MRI, conventional MRI with extracellular contrast agents, and biopsy as the initial diagnostic modality in patients with incidentally detected focal liver lesions suspected of being FNH or HCA. We analysed the cost and effectiveness, i.e. probability of successful diagnosis of each strategy. Costs were based on utilisation rates and Medicare reimbursements in the USA and South Korea. RESULTS: In the base case analysis of our decision tree model, the effectiveness of the three strategies was similar. The cost of the EOB-MRI strategy ($1283 in USA, $813 in South Korea) was lowest compared with the biopsy strategy ($1725 in USA, $847 in South Korea) and the conventional MRI strategy ($1750 in USA, $962 in South Korea). One-way, two-way and probabilistic sensitivity analysis showed unchanged results over an acceptable range. CONCLUSIONS: EOB-MRI strategy is the most cost-effective strategy for differentiating FNH from HCA in patients with incidentally detected focal liver lesions in a non-cirrhotic liver. KEY POINTS: ⢠The effectiveness of the three strategies was similar. ⢠The cost of the EOB-MRI strategy was lowest. ⢠EOB-MRI strategy is the most cost-effective for differentiating FNH from HCA.