Interventions:
The interventions were well described and appeared to have appropriate comparators. The usual practice in the US military and the recommended practice of the Disease Control and Prevention/American Thoracic Society were appropriately included as comparators.
Effectiveness/benefits:
The sources of effectiveness data were briefly described, so it was difficult to fully assess their quality. The use of a non-published study may have reduced the reproducibility of the study. It was unclear if a systematic review was undertaken, so all the best available evidence may not have been included. The benefit measure appeared appropriate, but the measure was quite disease specific which may reduced comparability with studies in other disease areas. The benefit measure was not discounted, which may have increased its uncertainty due to lack of benefit time-value accounting.
Costs:
The perspective was clearly stated and all the relevant categories appear to have been included. Little information was provided on the sources of the cost data, so it was difficult to assess their quality. It was unclear how resource use was estimated, which made it difficult to assess these estimates. The costs were appropriately discounted and adjusted for inflation.
Analysis and results:
The analytical approach was adequately described, with an appropriate model diagram provided. The sensitivity analysis undertaken provided a good indication of the uncertainty surrounding the various model inputs. However, it would have been useful to undertake probabilistic sensitivity analysis, which would have provided a good indication of the overall uncertainty in the model. The results of the study and the results of the sensitivity analyses were clearly reported. The authors mentioned several limitations and highlighted the uncertainty of the estimates of the cost and effectiveness inputs.
Concluding remarks:
The methods appear appropriate but were not well reported. It is difficult to assess the authors’ conclusions, particularly given the uncertainty surrounding the results.