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Allan S. Detsky, MD, PhD, FRCPC
University of Toronto Toronto, Canada

JAMA. 1990;263(11):1492.

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In Reply.—

Dr Adcock and Mr Terry are correct in pointing out that my study did not employ a random selection of trials. This article was a first step in the model's becoming operational, and as such I wished to select a group of trials that covered a wide range of costs and sizes of populations for which the therapies could be applied. The next step should be a random selection of trials, or, even better, all trials should be funded by specific agencies.

Dr Goldstein judges that two of the trials that accounted for the bulk of the costs were, in retrospect, not cost-effective in terms of life-years extended because they did not show a reduction in all-cause mortality. It is important to keep in mind that my model deals with the planning stage of the trial. That is, the model calculates the expected cost effects of the trial . . . [Full Text PDF of this Article]

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