Interventions:
The authors described the interventions in detail. Both treatment options were in use in the authors’ settings, and they are likely to be valid in other settings.
Effectiveness/benefits:
A systematic literature review was conducted to identify the primary studies for the clinical evidence. This was a valid approach to reduce selection bias in gathering the clinical data. The search methods and databases were fully described, but the details of the selected studies were not provided. QALYs were appropriately used as the benefit measure, and this will permit comparisons to be made across diseases. The sources of the utility estimates were reported, but the methods used to derive them were not.
Costs:
The cost categories were not consistent with the stated perspective, as no productivity costs were included, but the authors stated that this exclusion was due to limited data. The costs were presented as total categories, which limits the possibility of replicating the analysis in other settings. The sources of the economic data were reported and they reflected the US health care setting.
Analysis and results:
The costs and benefits were appropriately synthesised using a marginal analysis. The results were presented clearly. The sensitivity analysis was satisfactorily performed and its results were also clearly reported. The impact of uncertainty surrounding the model inputs would have been better assessed in a probabilistic sensitivity analysis. The structure of the Markov model was explicitly reported.
Concluding remarks:
The methods were good and the results were clearly reported. The authors’ conclusions appear to be valid.