Interventions:
The authors adequately described the interventions evaluated, which seemed of relevance to both their setting and the general care of patients with HCV infection. The authors explained the choice of the interventions. However, current practice did not appear to be included, presumably because the costs of treating HAV- and HBV-related complications were not included in the analysis.
Effectiveness/benefits:
The study was tailored to reflect the NMVAHCS perspective, and specific data about the prevalence of HAV and HBV immunity were retrieved. However, although the authors provided the references used for other parameters, it seems that a systematic review was not performed, so it is not clear that the best available evidence was used.
As the authors stated, the benefit measure chosen makes it difficult to compare the results with studies in other areas, or even in the same area that used other benefits (i.e. life-years). Since the health outcomes were not evaluated, the value of the vaccination strategies is not clear.
Costs:
Costs relevant to the study perspective and benefit measure have been included, and adequate local sources of the NMVAHCS were used. The costs of treating HAV and HBV complications were not considered in the analysis. This is consistent with the limited measure of benefit, but it does not adequately value the outcomes of the interventions. The selection of parameter ranges used in the sensitivity analysis was not justified.
Analysis and results:
The data selection process necessitated sensitivity analyses, which were appropriately performed. The results were well reported. The authors correctly did an incremental cost-effectiveness analysis, but the average cost-effectiveness ratios were unnecessary. The key issue when interpreting the results is how much the system would be willing to pay for an additional percentage point of fully immunised subjects. Although the authors stated that the results are probably not generalisable to other settings, they reported a two-way sensitivity analysis on key costs in order to assist decision-making in other settings.
Concluding remarks:
The authors presented a transparent analysis. However, the study does not adequately value the outcomes of the intervention, so the authors' conclusions should be interpreted with care.