Cost-effectiveness of iso- versus low-osmolality contrast media in outpatients with high risk of contrast medium-induced nephropathy
Abstract
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 contrastinduced 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 costeffectivenessthreshold 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.
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References
Thomsen HS, Morcos SK. Contrast media and the kidney: European Society of Urogenital Radiology (ESUR) guidelines. Br J Radiol. 2003;76:513-8. doi: http://dx.doi.org/10.1259/bjr/26964464
Berg KJ. Nephrotoxicity related to contrast media. Scand J Urol Nephrol. 2000;34:317-22. doi: http://dx.doi.org/10.1080/003655900750048341
Rihal CS, Textor SC, Grill DE, Berger PB, Ting HH, Best PJ, et al. Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention. Circulation. 2002;105:2259-64. doi: http://dx.doi.org/10.1161/01.CIR.0000016043.87291.33
Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis. 2002;39:930-6. doi: http://dx.doi.org/10.1053/ajkd.2002.32766
Barrett BJ, Carlisle EJ. Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. Radiology. 1993;188:171-8. PMid:8511292
Taliercio CP, Vlietstra RE, Ilstrup DM, Burnett JC, Menke KK, Stensrud SL, et al. A randomized comparison of the nephrotoxicity of iopamidol and diatrizoate in high risk patients undergoing cardiac angiography. J Am Coll Cardiol. 1991;17:384-90. doi: http://dx.doi.org/10.1016/S0735-1097(10)80103-2
Aspelin P, Aubry P, Fransson SG, Strasser R, Willenbrock R, Berg KJ. Nephrotoxic effects in high-risk patients undergoing angiography. N Engl J Med. 2003;348:491-9. doi: http://dx.doi.org/10.1056/NEJMoa021833
Solomon R. The role of osmolality in the incidence of contrast-induced nephropathy: A systematic review of angiographic contrast media in high risk patients. Kidney Int. 2005;68:2256-63. doi: http://dx.doi.org/10.1111/j.1523-1755.2005.00684.x
Pardo R, editor. Manual metodológico para la elaboración y adaptación de guías de práctica clínica basadas en la evidencia. 1ª edición. Bogotá: Universidad Nacional de Colombia; 2010.
Nguyen SA, Suranyi P, Ravenel JG, Randall PK, Romano PB, Strom KA, et al. Iso-osmolality versus low-osmolality iodinated contrast medium at intravenous contrast-enhanced CT: Effect on kidney function. Radiology. 2008;248:97-105. doi: http://dx.doi.org/10.1148/radiol.2481071484
Solomon R, Dumouchel W. Contrast media and nephropathy: Findings from systematic analysis and Food and Drug Administration reports of adverse effects. Invest Radiol. 2006;41:651-60. doi: http://dx.doi.org/10.1097/01.rli.0000229742.54589.7b
From AM, Bartholmai BJ, Williams AW, Cha SS, McDonald FS. Mortality associated with nephropathy after radiographic contrast exposure. Mayo Clin Proc. 2008;83:1095-100. doi: http://dx.doi.org/10.4065/83.10.1095
Klarenbach SW, Pannu N, Tonelli MA, Manns BJ. Cost-effectiveness of hemofiltration to prevent contrast nephropathy in patients with chronic kidney disease. Crit Care Med. 2006;34:1044-51. doi: http://dx.doi.org/10.1097/01.CCM.0000206287.22318.C3
Caicedo MA. Nefropatía por medios de contraste. Acta Med Colomb. 2007;32:68-79.
Subramanian S, Tumlin J, Bapat B, Zyczynski T. Economic burden of contrast-induced nephropathy: Implications for prevention strategies. J Med Econ. 2007;10:119-34. doi: http://dx.doi.org/10.3111/200710119134
Pannu N, Wiebe N, Tonelli M. Prophylaxis strategies for contrast-induced nephropathy. JAMA. 2006;295:2765-79. doi: http://dx.doi.org/10.1001/jama.295.23.2765
Thomson VS, Narayanan K, Singh JC. Contrast induced nephropathy in urology. Indian J Urol. 2009;25:437-45. doi: http://dx.doi.org/10.4103/0970-1591.57904
Lee PT, Chou KJ, Fang HC. Preventing contrast-induced nephropathy in patients with baseline renal dysfunction undergoing coronary angiography. Curr Treat Options Cardiovasc Med. 2009;11:71-8. doi: http://dx.doi.org/10.1007/s11936-009-0008-6
Barrett BJ, Parfrey PS, Vavasour HM, McDonald J, Kent G, Hefferton D, et al. Contrast nephropathy in patients with impaired renal function: High versus low osmolar media. Kidney Int. 1992;41:1274-9. doi: http://dx.doi.org/10.1038/ki.1992.189
Rudnick MR, Goldfarb S, Wexler L, Ludbrook PA, Murphy MJ, Halpern EF, et al. Nephrotoxicity of ionic and nonionic contrast media in 1196 patients: A randomized trial. The Iohexol Cooperative Study. Kidney Int. 1995;47:254-61. doi: http://dx.doi.org/10.1038/ki.1995.32
Aspelin P, Aubry P, Fransson SG, Strasser R, Willenbrock R, Lundkvist J. Cost-effectiveness of iodixanol in patients at high risk of contrast-induced nephropathy. Am Heart J. 2005;149:298-303. doi: http://dx.doi.org/10.1016/j.ahj.2004.07.020
Valls C, Andia E, Sánchez A, Moreno V. Selective use of low-osmolality contrast media in computed tomography. Eur Radiol. 2003;13:2000-5. doi: http://dx.doi.org/10.1007/s00330-001-1190-4
Gruberg L, Mehran R, Dangas G, Mintz GS, Waksman R, Kent KM, et al. Acute renal failure requiring dialysis after percutaneous coronary interventions. Catheter Cardiovasc Interv. 2001;52:409-16. doi: http://dx.doi.org/10.1002/ccd.1093
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