Author's Reply:

We would like to thank the author for taking the time to formulate a response to our article.1It raises an important topic, namely, the choice of comparators when applying the German efficiency frontier (EF) approach. In any economic evaluation, defining the comparators will greatly influence the results and conclusions.Because constructing an EF depends on at least 2 comparators,while also affecting the willingness-to-pay threshold, the influence of these comparators is increased further. The author casts some doubts on whether the comparators we used are sufficient to support our conclusions regarding the applicability of the EF and suggests it may be relevant to include historical treatment in the analysis. The author also mentions the natural disease course but agrees that this“may be difficult to obtain, given that the still-approved drug digitalis has been around for centuries.”1