Interventions:
The indication, dose, and frequency of the tamsulosin were well described, but it was not clear why calcium-channel blockers and alpha-receptor antagonists were not evaluated. Medical expulsive therapy might not be feasible in some settings, for instance, alpha-blockers were not approved for the treatment of ureteral stones in the USA.
Effectiveness/benefits:
The effectiveness data were based on a selection of relevant published literature, pooled estimates from meta-analyses, and a few authors’ assumptions. These key studies should be consulted to assess whether they produced valid model inputs. The time horizon was not stated, which makes it difficult to assess the duration of the expected health benefits, but all health outcomes seemed to occur within one year of referral.
Costs:
The perspective was not stated, but it included the direct medical costs and appears to have been that of the service provider. The authors argued that medical expulsive therapy complications were not included because they were rare and mild and unlikely to incur higher costs than complications from ureteroscopy. Specific cost components were not itemised and the price year was not reported, both of which hinder reflation exercises.
Analysis and results:
: An incremental cost-effectiveness analysis was appropriately performed. Sensitivity analyses tested the key variables, over wide ranges, to examine the stability of the base-case results. The authors acknowledged some limitations to their study including the omission of indirect costs, such as work time lost, and the inevitable cross-country differences in the clinical management of ureteral stones.
Concluding remarks:
In the absence of significant therapeutic complications, the authors' conclusions appear to be appropriate.