Care is required with cost effectiveness approach

doi:10.1136/bmj.321.7258.449

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Chris Cates, general practitioner (chriscates@emailmsn.com)

Manor View Practice, Bushey, Hertfordshire WD2 2NN

EDITOR—The argument in the letter from Taylor and Ebrahim starts from the premise that the cost of providing an anticoagulation service for patients with atrial fibrillation is 15 times higher than that of treating with aspirin.1 The inference that anticoagulation must be shown to be 15 times as effective as aspirin in the prevention of stroke is not correct because …