Interventions:
The interventions, including dosage and clinical techniques, were reported clearly. The authors provided justification for using the LA option.
Effectiveness/benefits:
The effectiveness data were derived from a small clinical trial in a single setting. Full details of the trial methods were reported and they appear to have been internally valid. The results were presented separately for each effectiveness outcome (pain, expectations, satisfaction and journey time), but in graph format only.
Costs:
The costs included in the analysis appear to have reflected those of the hospital perspective, although this was not explicitly reported. The cost methods were not reported transparently, most likely because the cost component was a small and secondary focus of the overall study. However, this will prevent the reader from fully ascertaining what methods were used for determining resource quantities and valuations and why, for example, the investigators chose not to include resources associated with preoperative counselling or postoperative infections. The price year was also not stated, which hampers any reflation exercises.
Analysis and results:
The health outcomes and net costs were not synthesised into cost-effectiveness ratios. In effect, a cost-consequences analysis was undertaken. The authors discussed their findings generally in relation to other techniques and specifically in comparison with one other study that found similar results when using LA. The authors did not raise any limitations of their study or suggest whether further research would be needed to support their claims.
Concluding remarks:
The reporting and methods used for the effectiveness outcomes were appropriate and clearly reported, whereas comprehensive information was lacking for the cost analysis. Given that the study involved a small sample from a single centre, the results pertaining to the cost components should be viewed with caution.