Interventions:
The selection of the comparators appears to have been appropriate in terms of reflecting the usual care versus the new strategy. These therapies are likely to reflect treatment patterns in other health care settings.
Effectiveness/benefits:
The approach used to identify the clinical sources of data was not reported. Thus, the sources may have been identified selectively. Short-term clinical estimates on treatment effect were derived from RCTs, which are usually considered to be a robust source of evidence given the strengths of the study design. However, the authors did not provide information on the sources used in terms of study populations and types of interventions, and the issue of potential heterogeneity among these sources was not addressed. Assumptions about long-term disease progression were based on published models and algorithms, which seems appropriate. The authors investigated the uncertainty surrounding some of these estimates in the sensitivity analysis. LYs are an appropriate benefit measure, and can be compared with the benefits of other health care interventions. The impact of the treatments on quality-of-life aspects was not investigated, although it would have been useful.
Costs:
The categories of costs included in the analysis were relevant to the perspective adopted in the study. The costs were presented as macro-categories and a detailed breakdown of the cost items was not provided. Some costs were related to the severity of disease. This approach is quite common in HIV studies, but reduces the transparency of the analysis. The sources of the costs and resource use data were only partially described. These issues tend to limit the study validity. Other aspects of the analysis, such as the price year and the use of discounting, were reported.
Analysis and results:
The synthesis of the costs and benefits was appropriate in its performance and presentation. The issue of uncertainty was addressed in the sensitivity analysis, which identified the most influential model inputs. Nevertheless, variability in these inputs was tested individually. Thus, alternative scenarios with simultaneous variations in model estimates were not considered. This might affect the generalisability of the study findings to other settings. However, the authors compared their findings with those of other published economic evaluations on EFN and found very similar results.
Concluding remarks:
The study methodology would appear satisfactorily, but the analysis was characterised by a lack of detail in the reporting of the sources used to populate the decision model. Thus, the authors’ conclusions should be considered with a degree of caution.