In reply:

I thank Dr. Niforatos for his interest in our study. He indicates that we performed a cost-effectiveness analysis of freestanding emergency departments (EDs), which we did not. Cost-effectiveness evaluations require measures of the costs of care relative to their net health benefits.1 Our study documented that the net costs of freestanding EDs are substantially higher than those for urgent care centers for the many diagnoses and procedures that are commonly observed at both locations.2

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