Engineers or Imagineers of Savings?

In Response: We agree that not all institutions are able to eliminate postanesthesia care unit (PACU) positions based on workload. However, as we indicated in our article, in order for the hospitals to take advantage of this reduction in magnetic resonance imaging (MRI) recovery nursing time, it is essential that they have the capability to move nurses between the various pediatric PACUs [1]. If one group of recovery nurses staffs all the PACUs including the MRI PACU, then the savings in nursing time in the MRI PACU can be directly translated to working hours in other PACUs. As a result of using propofol, the nurses assigned to the MRI PACU at Yale now have added responsibilities in other pediatric PACUs. Therefore, the statement made by Lubarsky about increased cost is valid only if the hospital does not have the capability to move nurses between various pediatric PACUs. In cost-benefit analysis, the consequences of a new drug are measured solely in monetary terms [2,3]. Better clinical outcomes are translated into dollar terms via approaches such as "willingness to pay" (that is, asking persons how much they would be willing to pay to receive a given health benefit). Both the costs of new medications and the clinical outcome are measured only in dollar terms [2,3]. As a result, the clinical outcome for the patient is costed very indirectly and incompletely by increased earnings [2,3]. Costeffectiveness analysis, on the other hand, measures the benefits or outcomes in biologic terms as well. Zeev N. Kain, MD Dorothy J. Gaal, MD Tatiana S. Kain, MD David D.