Interventions:
The selection of the comparators appears to have been appropriate, but little information was provided on the usual care.
Effectiveness/benefits:
The clinical evidence came from selected sources, which might have been known to the authors. Limited information on the characteristics of these sources was provided and this hinders the judgement of the validity of the clinical estimates. When available, data from Canada were used and the authors usually justified their selection of source for each model input and chose conservative estimates. The benefit measures were appropriate as they were the natural outcomes of the prevention programme, but they might not be directly comparable with the benefits of other health care interventions.
Costs:
The economic viewpoint was not clearly stated, but appears to have been that of the public payer. The costs were presented as overall categories, with no breakdown of cost items. This was due to the use of published estimates and an assessment of their methods of estimation was not reported. It was not clear that a discount rate was applied, but a rate of 3% was mentioned. The methods used to estimate the cost of death were described and appear to have been appropriate.
Analysis and results:
The authors reported the additional costs and benefits of the programme, without a clear definition of the outcomes associated with the two strategies. The incremental cost-effectiveness ratios and benefit-to-cost ratios were reported clearly. The variability in the clinical and cost estimates was assessed using ranges of values derived from published sources and models. The authors stated that conservative estimates were used to evaluate the cost savings and potential benefits associated with the programme.
Concluding remarks:
This study was based on estimates reported in other studies, the methods of which were not fully described. Caution is required in interpreting the authors’ conclusions.