The article by Jacobson and Rosenquist1 in this issue of JAMA advances the dialogue on whether to place appropriate limits on new medical technologies and, if so, how to do so. Physicians may not be aware of the dilemma faced by radiologists and hospital administrators arising from the recent introduction of low-osmolar contrast media (LOCM). This dilemma arises from uncertainty of just how much better these agents, which in the United States are ten or more times more expensive, may be.2 Since some 10 million examinations yearly use these intravascular contrast media and since the additional cost to the nation of the new agents totally replacing the old ones is close to $1 billion, the dilemma is crucial. (The use of low-osmolar, nonionic contrast media in myelography is not at issue, since the two new agents are cheaper and less toxic than the old agent metrizamide.)
Fischer HW. Cost vs Safety The Use of Low-Osmolar Contrast Media. JAMA. 1988;260(11):1614. doi:10.1001/jama.1988.03410110122042
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