Interventions:
The interventions were clearly described and were appropriate for the authors' setting. There might have been other relevant screening strategies, which could change the cost-effectiveness of these comparators. The authors did not explain why a screening frequency of every two years was considered.
Effectiveness/benefits:
The effectiveness data were mainly from two relevant French studies. A systematic review of the literature does not appear to have been conducted, which makes it difficult to determine if the most up-to-date and relevant data were used. The introduction suggested that these were the only relevant data, but this was not stated. The measure of benefit was disease specific and did not capture the impact of the intervention on a patient's quality of life, nor does it allow cross-disease comparisons to be made, but it was clinically meaningful.
Costs:
The costs reflected the stated perspective. Their sources were reported and appear to have been appropriate. Most of the resource use data were from the same trial that provided the clinical data, ensuring that correlated clinical and cost data were used. Little detail was provided on the resource use, which limits the transparency of the analysis. The price year was reported, allowing the results to be re-valued for future years. Other adjustments, such as discounting, were reported and appear to have been appropriate.
Analysis and results:
An incremental analysis was appropriately performed to determine the cost-effectiveness of each strategy. The results were clearly reported, but LYs gained would have been useful, as well as LYs lost, as the gain was the measure used for the cost-effectiveness ratios. The uncertainty was investigated, in a one-way sensitivity analysis, which was appropriate, but a more complete investigation would have included a probabilistic analysis. The authors discussed some limitations of their analysis.
Concluding remarks:
Assuming that the clinical evidence was the most relevant, the authors' conclusions seem to be appropriate for the strategies considered.