Interventions:
Both interventions were well described and appear to have been the treatments available in the study setting at the time. It was not clear which one was the usual practice.
Effectiveness/benefits:
The effectiveness data were published data from an observational study, which was of moderate methodological quality, and unpublished data and expert consensus. Insufficient detail was provided on these data sources to fully assess the quality of the evidence. There was no indication that a systematic review was performed to identify the sources, making it unclear if the best available evidence was used. The sources of data appear to have been relevant to the study setting.
Costs:
The authors reported the perspective and appear to have included the appropriate cost categories. The cost estimates were reported in a table and they were relevant to the study population and the setting. The price year and currency were reported, allowing future inflationary exercises.
Analysis and results:
The analytic approach was satisfactorily reported. The model structure was described and a diagram was given. The authors evaluated the uncertainty thoroughly in one-way, multivariate, and probabilistic sensitivity analyses. The results of the base case and sensitivity analyses were extensively reported. The authors discussed the limitations of their study, such as the lack of primary data, collected during an effectiveness-oriented randomised trial, for the model inputs. The authors stated that the PEDIG network had launched such a prospective randomised trial, to better estimate the rate of spontaneous resolution.
Concluding remarks:
There were a number of limitations in the evidence used in the model, but the methods and reporting of the study were satisfactory. The authors’ conclusions appear to be consistent with the evidence presented.