Interventions:
The interventions were clearly reported including the dosage. However, no explicit justification was provided for the comparators used. It is therefore unclear whether all the relevant comparators were included in the analysis.
Effectiveness/benefits:
The effectiveness data were derived from published studies, but no systematic search of the literature was reported. Although the sources of the data were provided neither the methods used to identify these primary studies nor the inclusion criteria were reported. Therefore, it is difficult to ascertain whether the best available evidence was used.
Costs:
The costs appeared to reflect the perspectives stated, and the cost data appeared to be appropriate for the study population and setting. However, the analysis of the costs was not thoroughly reported. Only the summary costs were provided, without the resource use and unit costs, which limits the generalisability of the analysis. The price year was reported, which will facilitate future reflation exercises.
Analysis and results:
The authors conducted two parallel cost-effectiveness analyses because no head-to-head comparison data were available in the literature. However, this could have been tackled by running a Mixed Treatment Comparison analysis. By doing this, it would be possible to compare the effectiveness of the three drugs involved and consequently to conduct a single cost-effectiveness analysis including all the drugs, which would have been more appropriate. Nevertheless, the methods were generally well reported and the results for the non-dominated strategies were fully and clearly presented. Sensitivity analyses were conducted on the model parameters, which enhances the generalisability of the findings and makes the results more robust. The authors outlined some limitations to their study.
Concluding remarks:
There were a few limitations to the methodology, so the authors' conclusions should be considered with a degree of caution.