OBJECTIVES: Iodinated contrast media are used in most interventional revascularization procedures. Several prior studies have demonstrated lower incidence of adverse clinical outcomes associated with iso-osmolar iodinated contrast media (IOCM) compared with low-osmolar contrast media (LOCM), including a recent analysis in comorbid patients with peripheral arterial disease (PAD). The objective of this study was to evaluate association of IOCM and LOCM use with direct costs and length of hospital stay in PAD patients undergoing endovascular interventions.

METHODS: : A retrospective analysis using Premier Healthcare Database (PHD) was carried out on comorbid patients who underwent peripheral endovascular procedures with IOCM or LOCM between September 2012 and June 2018. Diagnoses and procedures were identified using ICD-9, ICD-10, and CPT codes. Identified patients were separated into claudication and critical limb ischemia (CLI) cohorts. Hospital costs including imaging, pharmacy, room and board, and other direct costs were derived from the PHD chargemaster. Adjusted multivariable regression analyses was conducted using hospital fixed-effects specification to evaluate differences in total costs, hospital length of stay (LOS), and rate of home discharge associated with IOCM and LOCM.

RESULTS: 20,689 patients with primary diagnosis of claudication or CLI undergoing endovascular revascularization using either IOCM (9,634 patients) or LOCM (11,055 patients) were included in the analysis. In the overall cohort, patients who received IOCM had lower hospital LOS (estimated difference 0.96 days, p<.0001), lower total costs (estimated difference of $1,902 per patient, p<0.0001) and higher home discharge rate (estimated difference 3.2% p=0.0002). Claudication and CLI sub-cohorts showed similar outcomes favoring IOCM which were statistically significant for LOS, total costs, and home discharge rates

CONCLUSIONS: Use of IOCM compared with LOCM in comorbid patients undergoing endovascular intervention was associated with statistically significantly lower total costs and resource utilization. These economic outcomes are consistent with the clinical outcomes favoring IOCM in these populations.