We thank Dr. Sood for a very careful reading of our manuscript; for raising questions about our hypothetical financial analysis based on the 88 patients reported in the study; and for supplying several references that also contain discussions about the finances of INO.
Our paragraph in the manuscript describing theoretical savings was perhaps too briefly written. All we intended to imply is that the consistent use of INO in a group of term babies with severe hypoxic respiratory failure, all referred for possible ECMO use, was still associated with need for ECMO in 36 infants — but avoidance of ECMO in 52 other patients. We sought to calculate a theoretical savings based on the reductions in ECMO charges. We assumed that, as was true in our nursery and as now must be true in most nurseries, contemporary practice includes use of INO in all of these babies. Thus, in a sense, the $1,080,000 calculated INO charges for the group of 88 patients now would represent a standard charge, just as would be true for use of assisted ventilation devices and other intensive care procedures. We provided data for savings that would have accrued if all 88 patients had avoided ECMO and, more realistically, if the number of babies who avoided ECMO was in fact the 65% estimate gleaned from other publications.
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