Thomas S M, Williams J E, Adam E J
St George's Hospital, Department of Diagnostic Radiology, Tooting, London, UK.
Clin Radiol. 1997 Jan;52(1):59-61. doi: 10.1016/s0009-9260(97)80308-x.
Cost has been the major factor preventing the universal conversion to non-ionic contrast agents. We assessed the costs and potential benefits of making this change in our department. During a 10-month-period the use of all intravascular contrast agents and reaction rates were audited prospectively. One thousand three hundred and ninety-four examinations were included. A local protocol for the use of ionic and non-ionic contrast media was already in place, based on the Royal College of Radiologists Guidelines. For each patient the contrast agent used, risk factors, and presence or absence of a contrast reaction were recorded. Non-ionic contrast agent usage exceeded ionic by a factor of 10. Patients receiving ionic agents intravenously had a reaction rate of 16.8% compared with 2.7% for non-ionic contrast media. The use of ionic contrast media was subsequently suspended and the effect of this on overall costs assessed by retrospectively and prospectively analysing hospital expenditure on contrast agents. No increase in costs was found. The reasons for this are two-fold. Firstly in our institution the protocol in place and the nature of the workload resulted in relatively small volumes of ionic contrast media being used compared with non-ionic agents. Secondly, since our department is a bulk purchaser of non-ionic agents, substantial discounts could be negotiated. The benefits of non-ionic contrast media are well recognized and our experience suggests that cost may no longer be a barrier to conversion to these lower risk agents.
成本一直是阻碍全面改用非离子型造影剂的主要因素。我们评估了在本部门进行这一转变的成本和潜在益处。在为期10个月的时间里，对所有血管内造影剂的使用情况和反应率进行了前瞻性审核。共纳入了1394例检查。基于皇家放射科医师学院的指南，我们已经制定了关于离子型和非离子型造影剂使用的本地方案。记录了每位患者使用的造影剂、危险因素以及是否发生造影剂反应。非离子型造影剂的使用量超过离子型造影剂10倍。静脉注射离子型造影剂的患者反应率为16.8%，而非离子型造影剂的反应率为2.7%。随后暂停了离子型造影剂的使用，并通过回顾性和前瞻性分析医院在造影剂方面的支出，评估了这一举措对总体成本的影响。未发现成本增加。原因有两方面。首先，在我们机构，现有的方案和工作量的性质导致与非离子型造影剂相比，离子型造影剂的使用量相对较少。其次，由于我们部门是非离子型造影剂的大宗采购者，能够协商获得大幅折扣。非离子型造影剂的益处已得到充分认可，我们的经验表明，成本可能不再是改用这些低风险造影剂的障碍。
