Elsevier

American Heart Journal

Volume 149, Issue 2, February 2005, Pages 298-303
American Heart Journal

Clinical investigation
Outcomes, Health Policy, and Managed Care
Cost-effectiveness of iodixanol in patients at high risk of contrast-induced nephropathy

https://doi.org/10.1016/j.ahj.2004.07.020Get rights and content

Background

Acute renal failure after contrast-induced nephropathy is a clinically important and costly complication after the use of iodine-based contrast media. We investigated the cost and cost-effectiveness of 2 contrast media in patients at high risk of contrast-induced nephropathy.

Methods

The analyses were based on a randomized, prospective, multinational clinical study comparing the nephrotoxic effects of an isosmolar nonionic contrast medium, iodixanol, with those of a low-osmolar nonionic contrast medium, iohexol. Resource utilization data were obtained from the study and from a retrospective review of patients' hospital records. Swedish, German, and French unit prices were applied to resources used. Between-group differences in average costs were analyzed using a nonparametric bootstrap method.

Results

Resource utilization data for 125 patients were analyzed. Seven contrast media-related serious adverse reactions, of which 6 were acute renal failures, were noted in 6 patients receiving iohexol. Two patients in the iodixanol group had 1 nonserious reaction each. The mean hospitalization cost per patient was €489, €573, and €393 lower after iodixanol than after iohexol using Swedish, German, and French unit prices, respectively. The mean per-patient costs of treating adverse drug reactions were €371, €399, and €445 lower after iodixanol than after iohexol, using the respective unit prices (P ≤ 0.01). Iodixanol was cost-effective compared with iohexol, with both lower costs and better effects related to fewer adverse drug reactions.

Conclusions

The isosmolar contrast medium iodixanol appears to be cost-effective when compared with a low-osmolar contrast medium, iohexol, in diabetic patients with renal impairment undergoing angiography.

Section snippets

Protocol

Effectiveness and resource utilization data were based on the results reported in the study4 and combined with additional resource utilization data obtained from a systematic review of the hospital records of patients included in this clinical study. Data included in this economic analysis were obtained from the 129 patients at 17 European centers enrolled in this study from January 1999 to September 2001.4 Resource utilization data items were length of hospitalization, general practitioner

Study patients

Of the 129 per-protocol patients in the clinical study, 125 were included in this economic assessment (61 in the iodixanol group and 64 in the iohexol group). Of these, 122 underwent coronary angiography with or without percutaneous coronary intervention, and 3 underwent peripheral angiography. It was not possible to collect resource utilization data for 4 patients, either because the investigators participating in the clinical study had left the centers (3 patients) or patient data were not

Discussion

In our study, cost-effectiveness analysis indicates that iodixanol had both lower costs and better effects when compared with iohexol in a high-risk population. The mean costs per patient for treating serious adverse drug reactions were significantly lower in the iodixanol than in the iohexol group (differences are €371, €399, and €445 for Sweden, Germany, and France, respectively, all with P < .01). Although contrast medium costs for the IOCM iodixanol were higher per patient than for the LOCM

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