Interventions:
The selection of the comparators was appropriate as the authors compared the usual approach against the proposed strategy. These are likely to be relevant comparators in other settings.
Effectiveness/benefits:
The clinical data came from a prospective study that appropriately compared the two interventions. There was no randomisation, but the two study groups were comparable at baseline. The primary outcome measures were disease specific and might not permit comparisons with the benefits of other health care interventions. The demographic and clinical characteristics of the two groups were reported, but the size of the sample was not justified, making it unclear if it had sufficient power to detect statistically significant differences between groups. The two procedures were performed during two different periods and the authors did not investigate time-related bias in the study outcome; factors other than the interventions might have affected the performance of the two procedures. The authors acknowledged the importance of the learning curve in surgeon’s experience.
Costs:
The perspective was not stated, but the study focused on those costs borne by the authors’ centre. The unit costs and resource use were generally reported for the few cost items analysed. The resource use was from the same prospective study that supplied the clinical data. The sources of unit costs were not explicitly reported. The costs were treated deterministically and were not varied in the sensitivity analysis. The price year was reported and no discounting was necessary given the short time horizon of the study.
Analysis and results:
The results were clearly reported, but there were differences between those in the text, those in the abstract, and those in the table. The clinical and economic outcomes were not combined. In effect, a cost-consequences analysis appears to have been carried out. The uncertainty was not investigated and only the significance of the differences in clinical results was tested statistically. The results appear to be specific to the authors’ centre and will not be transferable to other settings. The main limitation of this study was the design of its clinical analysis.
Concluding remarks:
The authors’ conclusions appear to be appropriate, but some methodological limitations might affect the validity of the results.