Interventions:
The three interventions were reported clearly and in detail. In addition, a justification was given for using no screening as the comparator, which was that evidence from Maine had shown that routine testing was well below 100% for pregnant women.
Effectiveness/benefits:
The authors reported that an extensive review of the literature was undertaken to identify the relevant studies, and that where no evidence was identified, expert opinion was used. However, they did not report the methods of their review and selection of studies, so it is unclear if the most relevant data were used. They reported some details about the selected sources, but not the methods that were used to derive the utility estimates. They appropriately used estimates from clinical experts, but these are more uncertain.
Costs:
The perspective was appropriately reported and all the costs relevant to this societal perspective appear to have been included. The costs and their sources were adequately reported. The price year, currency, time horizon, and discount rate were appropriately reported, but the costs were inflated to 2004 prices using overall inflation indices, rather than health care inflation indices, which have been shown to be different.
Analysis and results:
Appropriate details of the model were reported, with a diagram. Although the impact of uncertainty in the model parameters was assessed in one-way sensitivity analyses, a more thorough assessment could have been made using probabilistic sensitivity analysis. The authors, in their discussion highlighted the main limitations of their study.
Concluding remarks:
Overall, the methodology was appropriate and the methods and results were adequately reported. Given the scope of the analysis the authors’ conclusions appear to be appropriate.