CT Cost and Performance Indicators Favor Use of Medrad® Stellant

Background

Optimal management of CT procedures associated with equipment for contrast-enhanced CT can positively and significantly influence efficacy and patient safety (Colombo 2013). Contrast medium injectors and their accompanying disposables are part of this equipment: Single or dual-syringe injection systems control various administration parameters of intravenous CM and saline through an interface (Indrajit 2015).

Daniel Upegui, Hospital Universitario Mayor, Bogotá, Colombia, and colleagues have now compared two dual-head injectors regarding cost, time and volume of contrast medium. The injectors were used for CT procedures in a tertiary care hospital in Colombia. Upegui et al. note that injector use in the institution’s daily clinical practice does not always adhere to manufacturer recommendations. Therefore, they evaluated both: routine use and recommended use.

Conclusion

The Medrad® Stellant CT Injection System combined with the Multi-Patient Kit (a multi-patient disposable set) was more efficient and led to lower total cost per procedure – while showing a high safety profile. The total cost per use of Medrad^® Stellant was 8% lower in the routine use scenario compared to second injector used. It could be up to 39% lower for the recommended use scenario.

Value Proposition

• The Medrad® Stellant combined with the Multi-Patient Kit leads to more efficiency in loading contrast and preparing the injector – preparation time was 23.3 seconds less for the Medrad® Stellant.
• The Medrad^® Stellant combined with the Multi-Patient Kit offers lower cost per test, if manufacturer recommendations are followed.
• The smaller amount of total CM with the Medrad® Stellant offers high patient safety. It potentially saves an average 11.5 liters of contrast per month in the above mentioned third level care institution.
• Reduction in injector loading and preparation time did not statistically influence the total time in the tomography room. However, this time reduction can be translated into a greater satisfaction of the radiology technologist, note the authors.

Methods

• Prospective Study
• Comparison between an empty syringe injector (Medrad® Stellant; Bayer, Berlin) and a prefilled syringe injector (OptiVantage®; Guerbet, Villepinte) for
  • Cost
  • Time
  • Volume of contrast medium
  • Use of resources
• 103 consecutive contrast-enhanced CT procedures during 4 days (47 with OptiVantage® prefilled syringes, 56 with Medrad® Stellant empty syringe system and Multi-Patient Kit).
• Contrast Media: Ultravist® or Optiray®
• Two independent observers: Documentation of each procedure regarding working time, injector preparation time, disposables, patient weight, estimated glomerular filtration rate (eGFR), nephroprotection requirement, type of CT performed, volume of CM injected and volume of CM discarded.
• Cost calculations:
  1. Routine use in the hospital for OptiVantage®.
  2. Recommended resource use according to manufacturer for OptiVantage®.

  3. Recommended resource use according to manufacturer for Medrad® Stellant.

     Cost calculations included disposables and CM, but also health and administrative personnel, depreciation of CT equipment, invoiced value for general services (i.e. security, cleaning, electricity, telecommunication).

Results in Detail

Cost

Comparison Routine Resource Use

Significant differences in

• cost of disposables (3.71 USD Medrad® Stellant vs. 1.48 USD OptiVantage®, p < 0.05)
• contrast medium (13.94 USD for Ultravist^®/Medrad® Stellant use vs. 19.52 USD for Optiray®/OptiVantage® use, p < 0.000).

No significant difference for average cost of the diagnostic test in this scenario: 32.93 USD Medrad® Stellant vs. 35.85 USD OptiVantage®. This sum includes disposables, CM, personnel and general services.

Comparison Recommended Resource Use

If disposables were used as recommended by the manufacturer, their cost increased considerably for OptiVantage®, from 1.48 USD to 19.5 USD. Disposables cost for the Medrad® Stellant system remained at 3.71 USD.
The cost for contrast medium did not differ from the routine resource use scenario.

In the recommended use scenario, average cost of the diagnostic test (disposables, CM, personnel and general services) increases considerably in the OptiVantage® injector group: from 35.85 USD to 53.88 USD. This implies a statistically significant difference between the OptiVantage® and the Medrad® Stellant group of 20.9 USD (p < 0.000).

The cost for consumables increases considerably in the comparator injector group, if the consumables are used as recommended by the manufacturer – from 35.85 USD to 53.88 USD. This implies a statistically significant difference between the OptiVantage® and the Medrad® Stellant group of 20.9 USD (p < 0.000).

The difference in total cost for the two injectors can increase from 8% for routine use to 39% for recommended use favoring Medrad® Stellant. This depends on the use of consumables during a 12-hour working day – whether it is continuous or the manufacturer recommends single per-patient use.

Injector Data

• Injector preparation time: 23.2 sec difference (p < 0.000)
  • 28.9 seconds (95%CI: 21.8-39.5) for Medrad® Stellant
  • 52.2 sec (95%CI: 46.7-56.7) for OptiVantage®
• Contrast medium volume: 8.7 mL difference (p < 0.005)
  • 59.7 mL (95%CI: 56.7-62.7) per patient for Medrad® Stellant
  • 68.4 mL (95%CI: 63.4-73.3) per patient for OptiVantage®
• No significant differences for
  • time spent in the tomography room (12.4 min for Medrad® Stellant vs. 12.2 for OptiVantage®),
  • time in the radiology area (35.3 min vs. 41.3),
  • amount of contrast medium wasted (1.8 mL vs. 1.4),
  • contrast medium volume in relation to weight (1.04 mL/kg vs. 0.96 mL/kg).

The study was funded by Bayer SA Colombia.

Average CT Injection Cost for disposables, CM, personnel and general services