John R. Mayo MD, Abstract Co-Author: Speaker, Siemens AG

Collette Louise English BMBS, FRCR, Presenter: Nothing to Disclose

Bruce Hartnett MBA,RT, Abstract Co-Author: Nothing to Disclose

We retrospectively assessed the allocation efficiency of universal kidney function testing for all patients receiving contrast media for CT versus risk factor screening as measured from the perspective of both the patient outcome and public funding.

Contrast Induced Nephropathy (CIN) rates in patients receiving contrast with GFR < 60 in a tertiary acute care using a universal testing policy were calculated. A standard Cost Benefit Analysis was used to assign standing, identify and monetize impact categories, obtain present values of costs and benefits, and perform a sensitivity analysis. Actual testing and patient costs were calculated. Benefits were derived from the number of avoided cases of Nephropathy Requiring Dialysis (NRD) and avoided deaths

The social benefits of screening all patients for impaired renal function versus testing those with risk factors is centered on finding occult renal impairment. Based on our site’s CIN rate with universal screening (0.34%), the extrapolated risk of missing someone during screening who would then go on to develop NRD was calculated to be 0.0021% (proportion of patients found to have occult kidney function < 60 x proportion of patients that are likely to develop NRD). The benefit of a blanket kidney function testing policy then, for a site administering contrast to~7,800 patients/year, was the prevention of 0.0036 NRD cases/year and, based on literature estimates, the saving of 0.0012 lives/year. The actuarial values calculated for these benefits, including adjustments for Quality Adjusted Life Years, was of the order of magnitude of ~$9,000 versus the ~$165,000 cost estimated to send 7,000 patients for additional blood-work.

We found the net social benefit of a blanket kidney function screening policy versus risk factor screening, was negative. We note political feasibility costs for health care practitioners were not assessed nor monetized. A risk stratification policy for GFR testing substantially reduces the tested population and the cost while preserving the proportion of patients receiving prophylactic hydration and/or alternative imaging strategies.

Risk stratification policy for GFR testing substantially reduces the tested population and the cost while preserving the proportion of patients receiving prophylactic hydration and/or alternative imaging strategies.

Mayo, J, English, C, Hartnett, B, An Ex Post Cost-Benefit Analysis of Kidney Function Screening for all Patients Prior to Iodinated Intra-vascular Contrast Administration during Computed Tomography.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14019463.html