Interventions:
The interventions were clearly reported and appear to have been appropriate comparators.
Effectiveness/benefits:
The effectiveness data were from a literature review, which was not described, making it impossible to determine if all the relevant information was included. The benefit measure appears to have been appropriate as it assessed morbidity and mortality, but how these utilities were combined and the studies from which they were derived were not described, making it difficult to fully assess their quality. The disutility of having a hysterectomy might not have been considered, and this could be important for women aged 30 years who were of child-bearing age. The authors discussed this issue, stating that more evidence on patient preferences for each intervention was required.
Costs:
The authors reported that a societal perspective was adopted, but they did not include productivity losses due to absence from work and it appears that a health care system perspective was analysed. All the major costs relevant to this perspective appear to have been included. The authors reported the sources for the costs. The costs of cancer care were from 1984, inflated to the price year, but clinical practice, and therefore the cost items, are likely to have changed over time, making these costs estimates uncertain. The price year, time horizon, discount rate, and currency were reported.
Analysis and results:
All the cost and outcome information was synthesised in a decision tree. The model structure was described and diagrams were presented. The results were adequately reported and the model uncertainty was tested in a probabilistic and one-way sensitivity analyses. As the main limitation to their study, the authors reported that there was a lack of published evidence for Lynch syndrome.
Concluding remarks:
Most of the methods were adequate, but some were not well reported, particularly for the costs and utilities. This makes it difficult to fully assess the authors' conclusions.