Interventions:
The interventions were described in detail and were justified. They appeared to be relevant interventions for the population and setting.
Effectiveness/benefits:
The authors described in detail how the effectiveness and benefit measures were derived. The study and baseline patient characteristics were presented. The gold standard was determined by the consensus of an expert panel on the basis of all the available clinical and investigation information. The authors justified using this consensus method over independently and blindly assessing the results.
Costs:
The costing section was brief. The authors included only the cost categories of the investigation (tests) and surgery. It is not clear, from the details reported, what these two cost categories contained. For example, it is not possible to determine whether the staff costs were included. Future lifetime costs saved were roughly assumed and, although these were subjected to sensitivity analysis, it is difficult to determine whether the range and baseline estimate were appropriate. No discounting appears to have been carried out despite the long time horizon and the price year was not reported, which will hinder reflation exercises.
Analysis and results:
An incremental analysis was conducted, but the comparators were not ranked and compared to the next most effective one, instead each comparator was compared with VEM and MRI alone. Whilst the majority of the results were presented, it is not clear that all of the data required to calculate the ICERs was presented. The reader was referred to online supplemental tables for some results. The authors noted limitations, which included the lack of outcome data in non-operated patients, and the non-universal performance of PET for all patients. Overall, the reporting was fairly transparent and the lack of some information may have been due to space limits, but the cost analysis was fairly weak.
Concluding remarks:
There were a few limitations so the authors’ conclusions should be considered with a degree of caution.