In Lisa Scott's evaluation of the cost-benefit of contrast agents ("Use of imaging agents underscores battle to control costs," March 28, p. 42), it was revealing to see nine references to cost and only two mentions of the benefits.
The assessment of the cost-benefit dilemma by Ms. Scott and the Rand Corp. researchers exemplifies a real issue facing administrators today- decisionmaking based solely on direct cost, not the larger issues of patient care and indirect costs.
The increased safety of low-osmolality contrast media vs. high-osmolality contrast media, shown by the reduction in adverse reactions, is undisputed in the literature. In focusing attention on the type of reactions avoided by LOCM, the fact that the type of contrast media used is at the root of the reactions is overlooked. Several large-scale studies have shown HOCM to be an independent and major risk factor for moderate and severe adverse reactions.
Regarding cost, we urge administrators to examine all costs of HOCM: The additional hospital costs of treating adverse reactions, including drugs and supplies, additional physician/nurse/
technologist time and lost procedure time. On the other hand, a closer look at LOCM reveals additional savings from manufacturer rebates, group-purchasing contract pricing and efficient use of the agents through volume management programs.
As administrators continue to evaluate the cost-benefit equation of contrast media choice, we urge them to embrace the broader perspective of overall cost as well as quality of patient care; these need not be mutually exclusive.
JANE ROHLF, M.D.
Vice president of medical affairs
Sanofi Winthrop Pharmaceuticals