The Introduction of Low-Osmolar Contrast Agents in Radiology

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Abstract
This case study of the public policy implications of introducing a new technology in radiology, namely, low-osmolar contrast media (LOCM), raises the issues of whether and how to place appropriate limits on new technologies. Although these contrast media represent small episodic costs, they may add up to an aggregate expenditure of nearly $1 billion per year if used for all contrast injections. As a result, this technology raises a number of important medical, economic, legal, and public policy questions. Our cost-effectiveness analysis and an analysis of the medical evidence suggest that LOCM should be limited to high-risk patients. We discuss in this article how the legal system might respond to such limitations, and we consider various public policy options for adopting restrictions on use. We conclude that the medical profession should take the lead in developing protocols for appropriate assessment, reimbursement, and use of LOCM. (JAMA1988;260:1586-1592)