Claims review may guide evidence-based approach to contrast-shortage mitigation

Iodinated contrast is most widely used in patients undergoing CT studies for, in descending order, abdominopelvic, chest, head/neck and brain indications, according to a review of 9.6 million Medicare Part B claims filed in 2019.

The review was conducted by researchers at the Harvey L. Neiman Health Policy Institute during the current shortage of GE Healthcare’s Omnipaque (iohexol injection) and posted by JACR May 23 [1].

Enhanced abdominopelvic scans were far more in demand than any other, with almost 14,000 exams per 100,000 Medicare beneficiaries:

1. Abdomen/pelvis: 13,952
2. Chest: 9,685
3. Head/neck: 2,732
4. Brain: 1,961
5. Cardiac: 355
6. Spine: 343
7. Extremity: 300

Richard Duszak Jr., MD, Elizabeth Rula, PhD, and colleagues also found CT contrast utilization highest in outpatient and emergency hospital settings (10,728 and 8,740 per 100,000, respectively). Rounding out this list were inpatient hospital (5,929), physician office (3,816) and other imaging sites (125).

Breaking out CT angiography studies minus cardiac CT, the researchers found contrast-enhanced brain exams far ahead of the runners-up—head/neck, chest, extremity and abdomen/pelvis.

Duszak and co-authors acknowledge the uncertain generalizability of their findings to patients with coverage other than Medicare fee-for-service while noting:

Given the daunting challenges associated with most effective rationing of limited contrast resources, we believe that empiric utilization data could help prioritize and inform professional society guidelines and health system decision making by focusing mitigation strategies on areas in which contrast is most frequently used. Since institutional and enterprise data on local contrast agent utilization may be variable in availability, completeness, and quality, national benchmark information could prove useful.”

In a news release sent by the Neiman organization, Duszak, presently with Emory University, adds that the results of the study “can help guide current intense efforts nationally and institutionally to identify strategies to minimize or avoid iodinated contrast use by using alternative imaging modalities, contrast agents or protocols that reduce or minimize waste resulting from individual doses.”

Full study here, news release here.