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October 4, 1995

Cost-effectiveness of Noninvasive Testing for Osteomyelitis-Reply

Author Affiliations

New England Medical Center Boston, Mass

JAMA. 1995;274(13):1013-1014. doi:10.1001/jama.1995.03530130019015

In Reply.  —Economic analyses of health care strategies must carefully differentiate costs from charges.1 Costs represent the actual amount paid for resources consumed in providing a service, while charges represent the price requested for reimbursement of that service. Because market forces affect charges, large and seemingly arbitrary differences between costs and charges for different services may exist.2 We agree with Dr Makler that it is important to use costs, which correspond more closely to actual resource consumption, and not charges, when performing cost-effectiveness analyses.Makler believes that the costs listed in our analysis are not representative, quoting the 1993 Medicare resource-based relative value scale—based reimbursement for a three-phase bone scan of $204.06 as proof. We believe this is an underestimate, which may include neither the costs of the radiopharmaceutical nor the hospital costs for the addition of a three-phase scan to the regional scan. Unfortunately, even costs vary