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Correspondence: reply  |   December 1995
Comparison of Estimated Variable Costs Is a Surrogate for Actual Cost Experience
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Airway Management / Ambulatory Anesthesia / Infectious Disease / Neuromuscular Diseases and Drugs / Practice Management / Respiratory System
Correspondence: reply   |   December 1995
Comparison of Estimated Variable Costs Is a Surrogate for Actual Cost Experience
Anesthesiology 12 1995, Vol.83, No Pagination Specified. doi:
Anesthesiology 12 1995, Vol.83, No Pagination Specified. doi:
In Reply:--Johnstone correctly states that our study does not replace analyses of actual costs experienced by different providers using the laryngeal mask airway (LMA). Although we incorporated some actual monetary expenditures (e.g., dental injury), a more precise cost profile for the LMA could result from a randomized clinical trial comparing different airway management techniques. Alternatively, relevant clinical and economic data may be available from administrative databanks maintained by integrated health-delivery networks. Each of these methodologies benefits from a study like ours because our study identifies the key variables that need to be measured.
Certainly, the costs factored into an economic analysis of medical practice vary depending on the point of view (e.g., patient, provider, payer, society) that the analysis takes. Because we were motivated to do the study to improve operating room efficiency, our analysis took the perspective of the provider (hospital). If the analysis had been conducted from the point of view of the society, for instance, other less tangible costs, such as those related to productivity losses due to succinylcholine myalgias or sore throat from tracheal intubation, would have been included.
Johnstone states that the average cost at his hospital for aspiration pneumonia is $16,088. Even if this figure represents true hospital costs and not charges, an insight from our analysis was that the overall results are not sensitive to changes in costs for aspiration pneumonia. This is because the incidence of clinically significant pneumonia requiring treatment in healthy outpatients is extremely low.
Alex Macario, M.D., M.B.A., Pearl Chang, M.B.A., Dan Stempel, M.B.A., John Brock-Utne, M.D., Department of Anesthesia, Stanford University School of Medicine, Stanford, California 94305–5115.