In reply to Dr Brolmann's letter concerning the economic aspects of the study, we agree that the individual costs used in the economic evaluation are not reported in the paper—this was purely to reduce the length of the paper and not to conceal information. This is also the reason why we did not include additional information about the choice of cost categories.

A single set of unit costs were used for both arms of the trial. The cost per minute in theatre based on an extensive costing exercise carried out by Stobhill Finance Department was £11.90. Likewise, the cost per inpatient day was calculated as £189.60. The confusion the authors identify is related to the fact that Table 4 reports median and mean costs per women. These therefore, reflect the different experience each woman had of her surgery and subsequent inpatient stay (including such factors as additional tests, requirements for further surgery, etc.) rather than costs hypothesised on the basis of the expected package of care.

We acknowledge that the milestones in the paper are not validated although they do seem sensible as they are important to the women in question. However, we also used Euro Quol 5D to compare the two groups at baseline, one month, six months and one year post-operation. This is a validated generic measure of health state with which I am sure the correspondent is familiar.

Indirect costs are a controversial area and are excluded because we felt that an NHS perspective was most useful to inform decision making. Our results show that women did not reach the milestone of returning to normal activity or work earlier following laparoscopic-assisted vaginal hysterectomy, and thus, indirect costs would not be affected.