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February 13, 1995

Does 'Aggressive Approach' Equal Higher Cost?-Reply

Author Affiliations

Cleveland, Ohio

Stanford, Calif

Montreal, Quebec

Arch Intern Med. 1995;155(3):335. doi:10.1001/archinte.1995.00430030133020

In reply  In his letter, Forwand requests more information on costs of cardiac care in an American compared with a Canadian institution. We performed an economic analysis but did not present it in the article1 because of several limitations inherent to such an analysis. These limitations include incomplete information on all services required for the care of patients with myocardial infarction, lack of itemized cost accounting in Canada, and lack of a common cost unit between the two countries.To answer the letter, we include our calculations, realizing that they exhibit some of these limitations. We used charges obtained from Stanford's (Stanford University, Palo Alto, Calif) accounting department for 1989 to 1990 and applied them to the service volumes in both institutions. Our analysis shows that the average charge per patient for in-hospital treatment of acute myocardial infarction was US $18895 at Stanford and US $14 144 at McGill