Interventions:
The interventions were clearly reported including dosage and detailed clinical techniques. The authors justified their use of the CVVH plus RCA treatment.
Effectiveness/benefits:
The effectiveness data were derived from a small sequential cohort study carried out in a single setting. The details of the study methods were transparently reported and they appear to be internally valid. Although the study was not a randomised controlled trial, and so could be prone to bias or confounding, the participant demographic and biochemical profiles were shown to be similar at baseline. The results were presented separately for each effectiveness outcome and comparisons with similar studies were discussed.
Costs:
The costs appear to reflect those of the hospital perspective although this was not explicitly stated. The cost methods were not reported transparently. This is likely to be due to the cost component being a small and secondary focus of the overall study. However, it does not allow the reader to fully ascertain the methods used for determining resource quantities and valuations and why, for example, the investigators chose their cost formula or why an hourly measure was used. In addition, the price year and currency exchange rates were not stated making any reflation exercise difficult.
Analysis and results:
The health outcomes and net costs were not synthesised into cost-effectiveness ratios and, in effect, a cost-consequences analysis was performed. The authors discussed their findings generally in relation to other techniques, and specifically in comparison with other studies reporting similar results, using the same technique. The authors acknowledged several limitations of their study, but did not suggest that further research within a randomised trial design was needed to support their claims. The limited cost detail highlights the fact that the main focus of this analysis was on clinical outcomes.
Concluding remarks:
The reporting and methods used for the effectiveness outcomes were appropriate and clear, whereas there was a lack of comprehensive information on the cost analysis. Given that the study involved a small observational sample from a single centre, the cost results should be viewed with caution.