An Economic Analysis of Strategies for the Use of Contrast Media for Diagnostic Cardiac Catheterization

Brendan J. Barrett, Patrick S. Parfrey, Robert N. Foley, Allan S. Detsky

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


A decision tree model was used to estimate the incremental cost per quality-adjusted life year (QALY) of low- as opposed to high-osmolality contrast media for cardiac angiography. Analyses were done from the viewpoints of a third-party payer and society using data from a randomized trial and the literature. Assuming low-osmolality media reduce the risk of myocardial infarction and stroke, the incremental cost per QALY gained with these media is $17,264 in high-risk or $47,874 in low-risk patients for a third-party payer. From a societal viewpoint, the corresponding costs are $649 and $35,509. These estimates are sensitive to the cost and volume of the contrast medium employed and to the estimate of reduction in severe adverse events with low-osmolality media. The authors conclude that, in the context of restricted budgets, limiting the use of low-osmolality media to high-risk patients is justifiable, as the incremental cost per QALY in high-risk patients may be reasonable and it is not certain that low-osmolality media prevent severe or fatal events. A considerable reduction in the cost per QALY gained is possible by minimizing the volume of contrast medium used.

Original languageEnglish (US)
Pages (from-to)325-335
Number of pages11
JournalMedical Decision Making
Issue number4
StatePublished - Oct 1994


  • cardiac angiography
  • contrast media
  • cost-benefit
  • cost-effectiveness
  • cost-utility
  • economic analysis
  • high-osmolality
  • low-osmolality


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