August 1997

Invited Commentary

Author Affiliations

St Paul—Ramsey Medical Center St Paul, Minn

Arch Surg. 1997;132(8):925. doi:10.1001/archsurg.1997.01430320127022

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While O'Keefe and associates do not provide us with any new ideas, their approach is important. Their analysis employs costs rather than charges, which is an important concept that should not be overlooked. Cost data should be our standard measurement for an economic evaluation. Their cost-charge ratio is not the best method to assess cost, but it is an acceptable approach. True cost data would be the ideal.

The economic model they use is not fully described, although it is based on previous work and uses standard assumptions. The value of the model to predict costs based on clinical admission data is not clear, except as it is used to compare actual to predicted costs for this article. More likely a population-based actuarial economic model would be used to predict total trauma care costs. Which method is better is unknown.

Complications increase costs. No surprise! Yet, the authors note that

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