Interventions:
The interventions were clearly reported. They appear to have been relevant strategies in the authors' setting, as they had been included in randomised controlled trials and their cost-effectiveness had been evaluated in other settings. It was not clear if other relevant drugs were available and could have been considered in this analysis.
Effectiveness/benefits:
The clinical data on the efficacy of treatment were from a published randomised controlled trial and this design is generally considered to be a valid source of evidence. The full details of the trial were published elsewhere, but the authors provided some information, including the number of patients and the length of follow-up. From these details, the trial appears to have been of high quality, but to fully assess it the original publication would be required. The use of QALYs was appropriate as they capture the impact of the intervention on quality and length of life. Some information on the derivation of the utility scores was provided.
Costs:
The costs relevant to the Ministry of Health perspective appear to have been included. In general, the cost analysis was poorly reported, with the total costs associated with treatment and those of each complication, with its frequency, provided, rather than the unit costs and no further resource use data. Other adjustments including discounting and the price year were reported and appear to have been appropriate.
Analysis and results:
An incremental analysis was performed, and the full results were presented. The results of the sensitivity analysis were also clearly reported and discussed. Given that total, rather than unit, costs were reported, it might be difficult to generalise the results to other settings. The authors acknowledged some limitations to their analysis.
Concluding remarks:
There were some limitations to the reporting, especially concerning the costs, and the authors' conclusions should be regarded with caution.