April 17, 1991

Reducing High Blood Cholesterol Levels With Drugs

Author Affiliations

Medical Arts Laboratory Oklahoma City, Okla

Medical Arts Laboratory Oklahoma City, Okla

JAMA. 1991;265(15):1950. doi:10.1001/jama.1991.03460150053014

To the Editor. —  The treacherous nature and potential pitfalls of "cost-effectiveness analysis" are illustrated in part in the recent article by Schulman et al.1Costs are notoriously difficult to identify and define. Misidentifying costs can warp results. The authors based laboratory costs on the workload recording manual of The College of American Pathologists2 (which they referred to as a "relative value scale"), adjusted by Maryland hospital "costs per work unit."The College of American Pathologists' workload method is not a relative value scale. It is solely a standardized method of evaluating the time required of medical technologists to perform a test. It cannot accurately be converted into total costs, since all of the other laboratory costs are not linearly correlated with personnel costs. The manual cited was even 8 years out of date.For the purpose of assessing costs of lipid-lowering regimens, independent laboratory costs are more