The effect of major adverse renal cardiovascular event (MARCE) incidence, procedure volume, and unit cost on the hospital savings resulting from contrast media use in inpatient angioplasty.

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.

Assessment of neovascular permeability in a pancreatic tumor model using dynamic contrast-enhanced (DCE) MRI with contrast agents of different molecular weights.

OBJECT: We evaluated the relationship of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)-derived pharmacokinetic parameters and contrast agents with different molecular weights (MW) in a pancreatic tumor mouse model. MATERIALS AND METHODS: Panc02 tumors were induced in mice at the hind leg. DCE-MRI was performed using Gadolinium (Gd)-based contrast agents with different MW: Gd-DOTA (0.5 kDa), P846 (3.5 kDa), and P792 (6.47 kDa). Quantitative vascular parameters (AUC, K(trans), V(e), and V(p)) were calculated according to a modified Tofts two-compartment model. Values for all contrast groups were compared for tumor and control (muscle) tissues. RESULTS: Values for K(trans) and V(e) were significantly higher in tumor tissue than in muscle tissue. When comparing contrast agents, lowest absolute K(trans) values were observed using P792. The relative increase in K(trans) in tumor tissue compared with normal tissue was highest after the use of P792. In both tumor and normal tissues, K(trans) decreased with increasing molecular weight of the contrast agent used. CONCLUSION: It was demonstrated that values for the different DCE-MRI vascular (permeability) parameters are highly dependent on the contrast agent used. Due to their potential to better differentiate tumor from muscle tissue, higher molecular weight contrast agents show promise when evaluating tumors using DCE-MRI.

Contrast medium induced nephropathy: new insights into prevention and risk management.

Diagnostic and interventional cardiac imaging modalities employing contrast media (CMs) have become increasingly widespread in the recent years, especially multi-slice coronary computed tomography (MSCCT) and percutaneous coronary intervention (PCI). Contrast medium induced nephropathy (CIN), defined as impairment of renal function within 48-72 hours after administering CM, is one of the most common causes of hospital acquired renal insufficiency. The overall incidence of CIN in the general population is low (0.6-2.3%), but it may become remarkably elevated in patients with pre-existing renal failure, diabetes mellitus and in the elderly, all of whom represent a large cohort of patients undergoing cardiac studies. Calculating a simple risk score that is based on readily available information can assess the overall risk of CIN in each individual patient. Volume supplementation in moderate-high risk patients remains the cornerstone for preventing CIN. The combination of oral volume overload and intravenous (i.v.) hydration with normal saline (NS) or bicarbonate significantly reduces the risk. Since no ideal CM exists, preventing CIN involves reducing the given volume, avoiding the use of high osmolality or high viscosity CM, and limiting repeated exposure. Several vasodilators have been tested and controversial results have been observed. Recently, considerable interest has arisen due to the initial positive data on the effectiveness of antioxidant agents in reducing CIN incidence. In this review, we focus on the current strategies in the risk management of CIN and on the effectiveness of new preventive pharmacological therapies.

Adverse events with radiographic contrast agents: results of the SCVIR Contrast Agent Registry.

PURPOSE: To determine prospectively the incidence of adverse events in angiography related to contrast agents, and the relative incidence of events with use of high-osmolality contrast agents (HOCAs) and low-osmolality contrast agents (LOCAs) and to ascertain if risk factors can help identify increased risk of an adverse event and patients likely to benefit from use of LOCAs. MATERIALS AND METHODS: From 26 high-volume institutions, data were collected on every patient who underwent angiography from July 1, 1990, to June 30, 1992. Information included demographic and risk factors, general medical status, previous administration of contrast media, procedural information, occurrence and characteristics of all adverse events up to 12 hours after procedures, and relation to contrast agents, treatment, and outcome. RESULTS: In 60,891 patients, there were 75,616 studies, 56% with nonionic LOCAs, 8% with the ionic LOCA, and 36% with HOCAs. Most major risk factors correlated with an increased incidence of adverse events related to contrast media. Incidence of these adverse events varied with type of procedure, with a higher incidence associated with cardiac and interventional procedures. Overall adverse events related to contrast media and those for which treatment was necessary were significantly increased (P < .001) with use of HOCAs for all but arterial interventional procedures. Serious adverse events were not different between the two classes of agents except for cardiac procedures. Previous reaction to contrast medium was the most important risk factor in prediction of an adverse event. CONCLUSION: The safety benefit of use of LOCAs is limited. Patients most likely to benefit are those with a previous reaction or more than one other major risk factor. Selective use of LOCAs is an appropriate strategy.

Survey of contrast media use in southeastern U.S. hospitals.

This article reports the results of a survey of contrast media usage in hospitals in five southeastern states. Forty-three percent of hospitals surveyed reported using nonionic contrast media 100% of the time, while 71% used nonionic contrast more than 75% of the time. Hospitals with fewer than 399 beds showed an increase in universal nonionic contrast usage compared to hospitals with more than 400 beds. Survey results also showed that radiographers administer contrast media in 90% of hospitals. On average, radiographers administered contrast twice as often as radiologists. Hospitals favored selective protocols as the primary method to reduce nonionic contrast media usage. The low rate of reactions for nonionic contrast was the primary reason hospitals chose to use nonionic contrast.

Decision analysis to assess cost-effectiveness of low-osmolality contrast medium for intravenous urography.

Decision analysis was used to compare the cost-effectiveness of a conventional ionic high-osmolality contrast medium with that of a nonionic low-osmolality contrast medium when used for i.v. urography. The patient populations considered in the model were those with a low risk and those with a high risk of contrast medium-associated adverse effects. Mean toxicity rates for the contrast media were obtained from the literature. To estimate the average cost of adverse effects, the probability of a patient in each population developing a mild, moderate, or severe reaction was multiplied by the respective estimated cost for each level of severity, and the products were summed. The incremental cost of the low-osmolality medium per case of adverse effects prevented was calculated by dividing the difference between the average costs of the two media by the difference between the frequencies of toxicity associated with the agents. According to the 1990 cost data used, combined mean drug and toxicity costs were $68 and $13 for the low- and high-osmolality contrast media, respectively, per high-risk patient and $67 and $10 per low-risk patient. The incremental costs of the low-osmolality medium per case of severe adverse effects prevented was $17,974 in the high-risk population and $77,027 in the low-risk population. Sensitivity analysis showed the results to be stable over a range of data used in the model.(ABSTRACT TRUNCATED AT 250 WORDS)