We read with interest the paper by Cotton and associates1 on early discharge for patients with exacerbations of chronic obstructive pulmonary disease and the accompanying editorial by Killen and Ellis.2 In both publications the 1991 study of our RespiCare home care programme was referenced,3 and both asserted that our programme was not cost effective. In fact, our study reached the opposite conclusion—namely, that the RespiCare programme was shown to be cost effective.

Actual direct care charges in US dollars were used in our calculations of both pre-programme and on-programme costs. Additionally, administrative costs of operating RespiCare were added into the on-programme costs. Our findings showed that, while hospitalisation costs substantially decreased during the programme, home care costs increased. However, the decrease in hospital costs more than offset the subsequent increase in home care costs, with a total cost savings of $328 US dollars per patient per month or $3956 per year being realised for those on the RespiCare programme. Although the emphasis of the work was on improvements in clinical outcome, the cost savings were a significant and important aspect of our study.

I hope this clarifies any misunderstanding created by the recent articles.