David A. Asch, MD, MBA; John C. Hershey, PhD
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Asch DA, Hershey JC. The Illusion of Deterministic Rules. Ann Intern Med. 1997;127:165-166. doi: 10.7326/0003-4819-127-2-199707150-00025
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Published: Ann Intern Med. 1997;127(2):165-166.
TO THE EDITOR:
The recent article by Glassman and colleagues  contains several errors and may mislead readers about the promises and limitations of cost-effectiveness analysis.
First, their Table 2 reflects a 2.5% risk for rupture with aneurysms 3.5 to 3.9 cm in diameter, but their text reports a figure of 0.25%. Second, their Table 3, from which most of their conclusions are drawn, is inaccurate. A common mistake in calculating lives saved is not using a fixed reference point. In this case, a reasonable reference point is the number of patients who would die if no patients had surgery for aneurysms. Using their example, 2900 of 40 000 patients would die under those circumstances (3080 if the 2.5% risk for rupture is used for aneurysms <4 cm rather than the 0.25% we used). In either case, the number of lives saved for each threshold at each of the three hospital networks is calculated relative to this reference point. We believe that the correct figures are presented in the Table 1 on page 166.
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