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April 1, 1992

Cost Containment in Oregon: As Simple as A×B?-Reply

Author Affiliations

Duke University Durham, NC

JAMA. 1992;267(13):1780. doi:10.1001/jama.1992.03480130092029

In Reply.  —First, I have to admit that I do not completely understand everything Dr Goris is saying. I think that Goris' discussion of "isomorphism" and "a (risk) times b (benefit) is necessarily equal to b (risk) times a (benefit)" is based on his belief that Oregon was calculating benefit-risk ratios. (Read "a [benefit]" as "the benefit of treatment a," and so forth. Then "treatment a" will be equivalent to "treatment b" if a [benefit]×a [risk]=b [benefit]×b [risk].) Goris wants to be certain that if formulas like this are to be used, benefits and risks must be measured on numerical scales that have the properties required in order to make the formulas correct. It also appears that Goris believes I was endorsing Oregon's original formula, or endorsing Oregon's final method, or offering a correct method of my own.Based on these assumptions, I can offer the following