To the Editor.
—Drs Arevalo and Washington1 studied the "cost-effectiveness" of prenatal screening and immunization for hepatitis B virus. However, their methods mix benefit-cost and cost-effectiveness approaches. Their analysis is primarily a benefit-cost analysis, with all health events, savings, and costs put into dollar terms and the result expressed as a "net" cost or, as in their findings, benefit. In a cost-effectiveness analysis, results would be expressed in the ratio of dollars spent or saved per unit of health outcome, eg, $10 000 per case of chronic liver disease prevented or $1200 per quality-adjusted life-year gained. Cost-effectiveness analyses would not include indirect costs in the base case. "Cost-effective" is not the same as "cost saving."2Indirect costs are discounted in the analysis, but there is no statement that direct costs of medical care are discounted. Given the chronic nature of the sequelae of hepatitis B virus infection, which
Koplan JP. Prenatal Screening for Hepatitis B. JAMA. 1988;259(23):3408. doi:10.1001/jama.1988.03720230020018