Dr. Hendeles also criticized the use of average wholesale price (AWP) for medication costs in the analysis. We would first like to point out that, while savings in medications costs were noted, the greatest cost savings came from the reduction in hospital costs. Considering only medication acquisition costs fails to appreciate the total cost benefit one can achieve with appropriate therapy. In economic analyses, it is crucial to use a consistent standard for costs. This allows the comparison of results between studies. While we agree that AWP does not correspond to the cost paid for medications by many hospitals, in the United States it is a cost that often is used in analyses and is a well-accepted standard. For example, in the Format for Formulary Submissions, the Academy of Managed Care Pharmacy specifies the inclusion of AWP as part of the product information.3–
The book by Gold et al,4
a standard reference for cost-effectiveness analysis, also specifies AWP as a source of information for pharmaceutical transaction prices. Dr. Hendeles provides acquisition costs of $0.32 and $1.82, respectively, for racemic albuterol and levalbuterol. However, there is no information on where these costs come from, what hospitals or populations they apply to, and whether they would be appropriate and relevant for our analysis or other analyses. Without additional information and the standardization of costs, an analysis using the values suggested by Dr. Hendeles would not be comparable to any other analysis and would have limited usefulness.