Use of an intravenous contrast agent (Optison(TM)) to enhance echocardiography: Efficacy and cost implications

Objective: To compare the overall diagnostic costs associated with non- contrast and contrast echocardiography. Study Design: Phase III clinical trial. Patients and Methods: In a secondary analysis of data from a phase III clinical trial of the intravenous contrast agent Optison(TM), we compared the costs associated with obtaining a diagnosis in 203 patients who underwent non-contrast and contrast echocardiography. Costs for the initial test and any follow-up tests were derived from adjusted Medicare charges and a transition-1 microcost accounting system. Results: Diagnostic yield from echocardiograms was 87% with the use of Optison (3 mL) and 49% when no contrast agent was used (P < 0.001). Because technically inadequate echocardiograms were more common in the non-contrast group, follow-up testing was recommended for 42% of patients in this group compared with 12% of those who had undergone a contrast-enhanced echocardiogram (P < 0.001). Although use of Optison increased the initial diagnostic cost by $125, overall costs were 17% lower when Optison was used (P < 0.0001). Use of Optison also resulted in a 17% to 70% decrease in confirmatory transesophageal echocardiography, catheterization, and nuclear studies. Optison improved diagnostic accuracy by 2.7-fold in patients with an initial non-diagnostic echocardiogram, resulting in a substantial cost savings of $269 per patient. Conclusions: Use of Optison may improve the effectiveness of echocardiography and decrease the overall costs of obtaining an accurate diagnosis.