Economic evaluation of intravenous iodinated contrast media in Italy

Int J Technol Assess Health Care. 2014 Jan;30(1):69-77. doi: 10.1017/S0266462313000706. Epub 2014 Jan 31.

Abstract

Background: Contrast-induced acute kidney injury (CI-AKI) is defined as a deterioration in renal function after administration of radiologic iodinated contrast media (CM). Iodixanol, showed a lower CI-AKI incidence than low-osmolar contrast media (LOCM). A cost-effectiveness analysis was performed comparing iodixanol and LOCM in intravenous (IV) setting in Italy.

Methods: A Markov model was developed. Patients moved across four health states: CI-AKI free, CI-AKI, myocardial infarction, and death. The simulation horizon was lifetime with 1-month cycles. Costs and outcomes were discounted at 3.5 percent rate. CI-AKI incidence was considered from published literature across different definitions. Cost-effectiveness of iodixanol was assessed in terms of incremental cost per life-year gained. Net monetary benefit (NMB) was also calculated. Both deterministic and probabilistic sensitivity analyses were performed.

Results: Base-case results showed an average survival increase of 0.51 life-years and a savings of €7.25 for iodixanol versus LOCM. The cost-effectiveness of iodixanol was confirmed when other scenarios were explored, such as varying CI-AKI definition, sub-populations with specified risk factors, CM hospital bids prices, and inclusion of adverse drug reactions of allergic nature. An NMB ranging between €6,007.25 and €30,007.25 was calculated.

Conclusion: Base-case results show that IV iodixanol is cost-effective compared with LOCM in the Italian clinical setting of a hospital computed tomography radiology practice. However, some caution is due, mainly linked to inherent limitations of the modeling technique and to the lack of agreement on CI-AKI incidence data in the clinical literature.

MeSH terms

  • Aged
  • Consumer Product Safety
  • Contrast Media / adverse effects
  • Contrast Media / economics*
  • Cost-Benefit Analysis
  • Female
  • Humans
  • Infusions, Intravenous
  • Injections, Intravenous
  • Italy
  • Kidney Diseases / chemically induced*
  • Kidney Diseases / mortality
  • Male
  • Markov Chains
  • Models, Economic*
  • Osmolar Concentration
  • Risk Assessment
  • Risk Factors
  • Survival Analysis
  • Treatment Outcome
  • Triiodobenzoic Acids / adverse effects
  • Triiodobenzoic Acids / economics*

Substances

  • Contrast Media
  • Triiodobenzoic Acids
  • iodixanol