Interventions:
The three treatments represented the most widely used oral therapies in the secondary prevention of thrombotic cerebrovascular or cardiovascular disease. Thus, their selection was appropriate.
Effectiveness/benefits:
The clinical data were identified through a systematic review of the literature, the main criteria of which were reported. Only RCTs were included, which enhances the validity of the study, given their robust design. All these studies were pivotal trials, which have a high internal validity. The data from the trials were not combined, instead each study was used to generate a set of clinical inputs for different economic evaluations. The results of each trial were reported and the methodology used to derive the transition probabilities was described. In general, it seems that valid methodology was used. The derivation of the benefit measure was clearly described. LYs represent a commonly used measure, the benefits of which can be compared across different health care interventions.
Costs:
The categories of costs were consistent with the perspective. The costs were presented as macro categories and a detailed breakdown of cost items was not given. The use of macro categories is common, but this reduces the transparency of the economic analysis. The price year, discount rate, and currency conversions were presented. The sources of costs were only partially described.
Analysis and results:
The synthesis of costs and benefits was accurately performed and presented. The issue of uncertainty was extensively addressed by means of a probabilistic sensitivity analysis, the findings of which were clearly presented. The authors discussed some issues related to the validity of the specific clinical trials used for this economic evaluation and the impact of their findings on NHS guidelines.
Concluding remarks:
This economic evaluation was based on robust methodology, the sources and findings of which were clearly presented. The authors’ conclusions were valid and appropriate.
