Journal of Invasive Cardiology

Following the publication of the NEPHRIC study, Aspelin and colleagues published an analysis suggesting that, based on the incidence of clinically relevant renal failure in patients receiving iohexol in that study, iodixanol was more cost-effective than the low-osmolar agent in high-risk angiography patients.¹⁹ If a similar approach was applied to the data recently published by Solomon and Liss, the results might indicate the opposite.^12,13 What seems clear is that even in high-risk patients iodixanol is not better tolerated than all low-osmolar agents. Iopamidol in particular has a well demonstrated safety profile in renally impaired patients which is at least equivalent to that of iodixanol.
Pricing for nonionic contrast media varies by institution and depends on factors such as the size of the contract, the mix of products being purchased and membership in a particular group purchasing organization. Table 1 models the effect of cost differences between the low-osmolar contrast agent iopamidol ( Isovue^®-370, Bracco Diagnostics, Princeton, New Jersey) and the isotonic contrast agent iodixanol (Visipaque^™- 320, GE Healthcare, Inc., Princeton, New Jersey) using publicly available and calculated prices for these agents. Contrast media prices are bracketed on the high end by manufacturers’ list prices and on the low end by Federal Supply Schedule (FSS) prices, which are federally mandated “best-customer prices” that must be offered to large government purchasers such as Veterans Administration hospitals. According to the manufacturers, the current list price for a box of ten 200 mL bottles of Visipaque-320 is $1968.65 ($0.98/mL), while the list price for ten 200 mL bottles of Isovue-370 is $1,650.00 ($ 0.82/ mL).²⁰ At these prices, 2000 mL of Visipaque costs approximately 20% more ($315.00) than a comparable amount of Isovue. Given the 14% increase in iodine per mL contained in Isovue-370 versus Visipaque-320, 1 gram of iodine purchased as Visipaque-320 would cost $3.08, while the same gram of iodine purchased as Isovue-370 would cost $2.23.
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.