We thank Drs Lim and colleagues for giving us the opportunity to clarify several aspects of our analysis. The analysis includes the cost of laboratory evaluations and physician office visits for methotrexate therapy. We assumed that there were one level 3 and four level 2 physician visits and a liver biopsy specimen taken each year. We estimated the cost of physician and hospital fees by the 1996 Medicare reimbursement levels and drugs by the average wholesale price, a standard practice in cost-effectiveness analysis that allows broad comparisons across geographic areas and providers.1 The analysis also incorporates the loss of patient utility resulting from the 3% risk of cirrhosis associated with methotrexate therapy. Because the literature suggests that the clinical course of cirrhosis induced by methotrexate is nonaggressive,2- 7 the risk of cirrhosis did not influence survival or introduce substantial additional cost.
Chen S, Garber AM. Cost-effectiveness of Methotrexate and Goeckerman Therapy: A Flawed Analysis—Reply. Arch Dermatol. 1999;135(6):718. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-135-6-dlt0699