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William C. Black, MD
National Institutes of Health Bethesda, Md Georgetown University Medical Center Washington, DC

JAMA. 1989;261(10):1442.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

In their article entitled "The Introduction of Low-Osmolar Contrast Agents in Radiology," Mr Jacobson and Dr Rosenquist¹ conclude that low-osmolar contrast media should be limited to high-risk patients, for whom it is cost-effective. The authors calculate cost per year of life saved to be $106 000 ($3.4 million per 32 years) for average and $31 000 ($1 million per 32 years) for high- risk patients based on a life expectancy of 32 years for both groups. Clearly, however, many in the high-risk category, eg, elderly, diabetic patients with renal or cardiac disease, do not have a normal 32-year life expectancy. In fact, for high-risk patients with a life expectancy less than 9.4 years, the cost per year of life saved would exceed that for the average patient (despite the threefold risk of fatality in the high-risk patients). Such high-risk patients should not preferentially receive low-osmolar contrast media, . . . [Full Text PDF of this Article]

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