To the Editor.
— The article by Dr Eckman and colleagues1 regarding cost-effectiveness analysis in the diagnosis of foot infections is an extensive analysis that is fundamentally flawed because of an error in the assumptions about the costs of the procedures. The cost of the technetium Tc 99m bone scan is listed as $719 and the cost of the indium In 111—labeled leukocyte scan is put at $447. It may be that these numbers reflect the charges of the studies in the Boston, Mass, area, but these numbers do not reflect the cost of the studies.First, the listed costs of the studies are not representative. The 1993 Medicare resource-based relative value scale—based reimbursement for a three-phase bone scan is $204.06 (global payment comprising professional and technical fees), which is only a fraction of the $719 listed in Table 4 in the article.Second, the factor of concern is