The method used to obtain the effectiveness data was not clear. The cost data were not applicable to other countries. Moreover, as the authors themselves pointed out the study has several other limitations.
(1)Much of the data used were uncertain.
(2)The assumption of 100% sensitivity of ultrasound was questionable.
(3) Complications other than death were not considered.
(4) The assumption about the life expectancy of persons with successful surgical repair as being equal to that of the general population is of doubtful validity. However these limitations should favour the screening programme.