Dear Editor

Sutherland and Levesque have developed a useful conceptual framework to delineate warranted and unwarranted clinical variation in health care systems. They define unwarranted clinical variation as “patient care that differs in ways that are not a direct and proportionate response to available evidence; or to the healthcare needs and informed choices of patients.”Although this is a fairly comprehensive definition, the perspective of health economics appears not to be included. There are currently two dimensions of unwarranted variation in the health economics literature.