We thank Drs Gary C. Brown, Melissa M. Brown, and Sanjay Sharma for their thoughtful letter regarding analysis of costs in response to our article "Treatment Choice and Quality of Life in Patients With Choroidal Melanoma."1 The study of cost referred to by Michael Drummond, MD, and Linda Davies (written communication, 1990) was initiated by the National Eye Institute, Bethesda, Md, and to our knowledge the details have not been published. Therefore, it is difficult to comment on the discrepancies between the differential costs for enucleation and radiotherapy that Dr Drummond and Ms Davies calculated as compared with those that Brown et al suggest. To the possible reasons for the discrepancies that Brown et al cite, we would add that part may derive from the distinction between "cost" and "charge." We also note that costs (and certainly charges) may vary by geographic regions for intrinsic reasons owing to variation in treatment protocol. For example, we know that requirements for inpatient treatment and isolation for patients receiving radioactive plaques are extremely variable among the states. Nonetheless, their point is well taken, and as recommended by the US Panel on Cost-effectiveness in Health and Medicine,2 the cost differential between 2 modes of therapy deserves the same rigorous and scrupulous investigation and calculation devoted to other measures of patient outcome.
Cruickshanks KJ. Analysis of Costs. Arch Ophthalmol. 2000;118(3):444. doi: