Iodinated Contrast Media and Contrast-Induced Nephropathy: Is There a Preferred Cost-Effective Agent?
- Volume 20 - Issue 5 - May, 2008
- Posted on: 8/1/08
- 0 Comments
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On the low end, the Federal Supply Schedule (FSS) price for Isovue (10 units of 200 mL bottles) works out to $0.11/mL, while that for a comparable purchase of Visipaque is over three times as much ($0.40/mL).21 These prices, which are only available to large government purchasers, represent the highest available discounts from manufacturers on their products (87% off the list price for Isovue and 57% off the list price for Visipaque). Most contrast media users pay something in between the list price and the FSS price. If one takes the average between the list and FSS prices for these two agents, one can see that, at $0.69/mL, Visipaque-320 would cost approximately 50% more than Isovue-370, at $0.47/mL. In general, the discounts negotiated by large hospitals or group purchasing organizations represent approximately 50–75% off the list price for low-osmolar agents such as Isovue and 25–35% off the list price for Visipaque. Given the 19% difference in list pricing, this means that for most hospitals, the cost of using Visipaque is approximately two to three times the price of a comparable low-osmolar agent. Given the approximately 2 million invasive cardiac procedures performed annually in the U.S., the exclusive use of Visipaque could cost the health care system more that $300 million a year.
Given the lack of difference in clinically relevant outcomes between iodixanol and certain other nonionic agents and the substantial differences in acquisition costs, the use of iopamidol or a low-osmolar agent other than iohexol may be recommended at this time. Since 2004, over 35,000 patients at our cardiac catheterization laboratory have received Isovue-370 for their procedure. Given the roughly 10,000 catheterizations performed annually at our institution, and an average contrast agent volume of 200 mL per exam, the potential annualized cost savings of using Isovue instead of Visipaque amounts to approximately $630,000 (Table 1). In practice, this means that over the 3 years we have been using Isovue for our cardiac angiography patients, our institution has saved almost 2 million dollars versus what we would have paid had we been using iodixanol during that time. As the late United States Senator Everett Dirkson reputedly once said: “…a million here and a million there, and pretty soon you’re talking real money”.