OBJECTIVES: Contrast-induced adverse drug reactions (ADRs), including contrast-induced nephropathy (renal insufficiency and diabetes), are common among high-risk patients (e.g., patients with diabetes mellitus and renal impairment). These ADRs cause extended hospital stays and additional medication use, which lead to increased costs. We examined the cost-effectiveness of the use of two contrast media in patients at high risk for contrast induced nephropathy. METHODS: A decision-analytic model was constructed to estimate the cost-effectiveness of an isosmolar contrast agent, iodixanol, compared with a low-osmolar contrast medium, iohexol, in the United Kingdom (UK). Particular emphasis of the model was to avert the incidence of severe ADRs in patients at risk of contrast-induced nephropathy. The analysis is based on a multicenter randomized controlled trial conducted in fi ve European countries, the Nephrotoxicity in High-Risk Patients Study of Iso-Osmolar and Low-Osmolar Non-Ionic Contrast Media (NEPHRIC) trial. Patients receiving iodixanol versus iohexol experienced a statistically signifi cant reduction in the incidence of severe ADRs in favor of iodixanol. Patients in the study were adults aged 18 years and older referred for coronary or aortofemoral angiography who had diabetes and stable serum creatinine concentrations (men: 1.5 to 3.5 mg/dL; women: 1.3 to 3.5 mg/dL). Among the ADRs considered were acute renal failure, arrhythmia, cardiovascular events, pulmonary edema, and multiple-organ failure. Resource use, including hospital days, medical visits, contrast medium, medications, laboratory tests, and hospital procedures, were obtained from the NEPHRIC clinical trial. Unitcosts data were obtained from standard UK costing sources. Costs are reported in 2006 UK pounds. RESULTS: Iodixanol is cost-effective compared with iohexol; costs are lower and effects better, relating to fewer ADRs. The mean per-patient cost difference was £571.32 (£0.41 and £571.73 for iodixanol and iohexol, respectively). CONCLUSION: Iodixanol results in fewer ADRs and lower ADR costs per patient for this high-risk patient population.
