Interventions:
The interventions were clearly described and the selection of the interventions was justified. The study was thorough in the coverage of the interventions in the setting.
Effectiveness/benefits:
The effectiveness data were derived from a meta-analysis of RCTs. The selection of data from RCTs, given the strengths of their design, represents a valid source of treatment effectiveness. In addition, the search methods, inclusion criteria and details of the studies were clearly reported. The methods used to combine the data were included in the study, and appear appropriate and the outcome measure used was appropriate.
Costs:
The authors did not report a study perspective, so it is not clear if the appropriate cost categories were included. Unit costs and resource use data were correctly reported separately and their sources appear valid. No discounting of costs was necessary given the time frame of the analysis. The price year was not reported, so it would not be possible to revalue the results in future years.
Analysis and results:
No synthesis of the effectiveness and cost data was conducted and in effect, a cost-consequence analysis was performed. The impact of uncertainty on the study parameters was not fully investigated; only variations in the cost of endoscopy were considered. The authors noted some further limitations to their analysis.
Concluding remarks:
The methodology of the study appears to have been appropriate and, on the whole, was clearly and transparently reported. The conclusions reached by the authors appear to be appropriate. However, a sensitivity analysis of the estimates included in the study, as well as a synthesis of the cost and effectiveness data, would have strengthened their study.