Program
Economics
College
Arts and Sciences
Student Level
Doctoral
Start Date
7-11-2019 2:00 PM
End Date
7-11-2019 3:45 PM
Abstract
Gadolinium-Based Contrast Agent: An Economic Analysis Colin Sleeper1, Luisa Dominguez2, Kate Cartwright, PhD, MPH3,4, PhD4, Brent Wagner, MD5,6, David van der Goes1,4 , 1Department of Economics, University of New Mexico 2University of Texas at El Paso, 3School of Public Administration, University of New Mexico, 4 Combined BA/MD Program, University of New Mexico, 5The Kidney Institute of New Mexico and Department of Medicine, 6University of New Mexico Health Science Center Abstract: Gadolinium enhanced Magnetic Resonance Imaging (MRI) is a staple of contemporary diagnostic medicine (Leyba & Wagner 2019). Despite the uncertainty associated with their use, gadolinium-based contrast agents (GBCAs) are used extensively in MRI for a host of conditions. While GBCAs increase diagnostic efficiency, it is also known that gadolinium deposition is dangerous and therefore costly. There should be a careful consideration between the benefits and the costs associated with this practice to optimize patient health outcomes. One known adverse effect of gadolinium deposition is nephrogenic systemic fibrosis (NSF). Although the mechanism by which patients are affected by gadolinium deposition are not well understood, we can examine differences in health outcomes among different groups of patients. By utilizing Truven Health MarketScan insurance data, we will retrospectively create "treatment" and "control" groups of patients that share similar characteristics but differ in their exposure to GBCAs. We can use the differences in health outcomes over time to estimate the marginal cost associated with GBCA exposure. The benefits associated with increased diagnostic efficiency are usually information-based and associated with reducing uncertainty for the patient. When there is uncertainty, information or knowledge becomes a commodity. Like other commodities, it has a cost of production and a cost of transmission (Arrow, 1964). Traditional economic theory tells us that most patients have a preference for certainty (risk-aversion). We use this idea in the valuation of benefits associated with increased diagnostic efficiency of GBCAs. Ideally, we hope to create a tool by ordering physicians to target conditions for which the benefits associated with the use of GBCA outweigh the costs. References: Arrow K. J. (2004). Uncertainty and the welfare economics of medical care. 1963. Bulletin of the World Health Organization, 82(2), 141-149. Leyba, K., & Wagner, B. (2019). Gadolinium-based contrast agents: why nephrologists need to be concerned. Current opinion in nephrology and hypertension, 28(2), 154-162. doi:10.1097/MNH.0000000000000475
Gadolinium-Based Contrast Agent: An Economic Analysis
Gadolinium-Based Contrast Agent: An Economic Analysis Colin Sleeper1, Luisa Dominguez2, Kate Cartwright, PhD, MPH3,4, PhD4, Brent Wagner, MD5,6, David van der Goes1,4 , 1Department of Economics, University of New Mexico 2University of Texas at El Paso, 3School of Public Administration, University of New Mexico, 4 Combined BA/MD Program, University of New Mexico, 5The Kidney Institute of New Mexico and Department of Medicine, 6University of New Mexico Health Science Center Abstract: Gadolinium enhanced Magnetic Resonance Imaging (MRI) is a staple of contemporary diagnostic medicine (Leyba & Wagner 2019). Despite the uncertainty associated with their use, gadolinium-based contrast agents (GBCAs) are used extensively in MRI for a host of conditions. While GBCAs increase diagnostic efficiency, it is also known that gadolinium deposition is dangerous and therefore costly. There should be a careful consideration between the benefits and the costs associated with this practice to optimize patient health outcomes. One known adverse effect of gadolinium deposition is nephrogenic systemic fibrosis (NSF). Although the mechanism by which patients are affected by gadolinium deposition are not well understood, we can examine differences in health outcomes among different groups of patients. By utilizing Truven Health MarketScan insurance data, we will retrospectively create "treatment" and "control" groups of patients that share similar characteristics but differ in their exposure to GBCAs. We can use the differences in health outcomes over time to estimate the marginal cost associated with GBCA exposure. The benefits associated with increased diagnostic efficiency are usually information-based and associated with reducing uncertainty for the patient. When there is uncertainty, information or knowledge becomes a commodity. Like other commodities, it has a cost of production and a cost of transmission (Arrow, 1964). Traditional economic theory tells us that most patients have a preference for certainty (risk-aversion). We use this idea in the valuation of benefits associated with increased diagnostic efficiency of GBCAs. Ideally, we hope to create a tool by ordering physicians to target conditions for which the benefits associated with the use of GBCA outweigh the costs. References: Arrow K. J. (2004). Uncertainty and the welfare economics of medical care. 1963. Bulletin of the World Health Organization, 82(2), 141-149. Leyba, K., & Wagner, B. (2019). Gadolinium-based contrast agents: why nephrologists need to be concerned. Current opinion in nephrology and hypertension, 28(2), 154-162. doi:10.1097/MNH.0000000000000475
