Interventions:
The reporting of the interventions was generally good and it appears that the full range of available options was included. Where an option was excluded, this was fully justified. It is likely these interventions will be relevant for other settings.
Effectiveness/benefits:
The effectiveness data were adequately reported, except the utility values. The authors described the methods used to identify relevant studies, but did not state how they selected the source studies. It seems that all studies on colorectal cancer screening were identified and it is likely that the best available sources were used. The instrument used and whose preferences were elicited for the utility estimates, used to calculate the QALYs, were not described and the validity of the QALYs cannot be assessed.
Costs:
The reporting of costs was generally poor, particularly for indirect costs, and set-up and training, but the appendices provided some detail in tables, for the other costs. The measurement of the resource data and the methods used to analyse the cost data were not reported. Cost adjustments may have been necessary to convert from Singapore hospital costs to US $, but they were not reported. The costs were relevant to the stated perspective, but they were not comprehensive, for instance productivity losses due to early death from colorectal cancer were not listed.
Analysis and results:
An incremental analysis was appropriate to assess the relative cost-effectiveness of the numerous screening strategies. The authors considered the impact of uncertainty on the results, but a probabilistic sensitivity analysis could have assessed the overall impact of parameter uncertainty on the results. The reporting of the results was generally good and the authors discussed some key limitations to their study.
Concluding remarks:
The results were generally well reported, but the methods were not described in detail, making it hard to assess the authors’ conclusions.