Low-Osmolar Contrast Agents

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,