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Discussions of using CXRAY as a screening tool was on the technical aspect, but not on costing side as we did not conduct any cost effectiveness analysis or the social willingness to pay for such a strategy in similar settings.
As the population of patients evolves over time and patients with milder disease are treated, it is highly likely that any cost effectiveness analysis would suggest that a minor benefit potentially conferred by plasma exchange would come at too great a cost when compared with IV methylprednisolone.
One important point to note is that the results of any cost effectiveness or cost/benefit assessment in the US will be influenced by the type of payment system, and by the pay relativities between PA and any comparator group (e.g. physician or NP).
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As with any cost-effectiveness analysis, there are several limitations to this study.
Obviously, any cost-effectiveness evidence hinges on the presence of effectiveness evidence in the first place.
Limitations of this study are similar to those of any cost-effectiveness analysis.
15, 21, 27, 31 A number of limitations of any cost-effectiveness study have to be taken into account.
The validity of any cost-effectiveness analysis is only as plausible as the inputs and assumptions made within the model.
It is therefore necessary, in any cost-effectiveness analysis, to infer adverse event rates from error rates – a step that introduces further uncertainty.
In the absence of such trial results, any cost-effectiveness estimates are inevitably speculative, assuming a life year's benefit that has not yet been proven.
As with any cost-effectiveness results our results should be considered along with other health system goals such as equity and acceptability to stakeholders [ 50].
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