Interventions:
Details of the interventions were provided, but the two interventions were combined and compared with an alternative, which was not described in detail.
Effectiveness/benefits:
The clinical data came from a crossover trial; this design has a number of limitations, such as carry over and ordering effects, which might have influenced the clinical outcomes for the interventions. The size of the sample was not justified, making it unclear if the study had sufficient power to detect statistically significant differences between the groups. QALYs were an appropriate outcome measure capturing the impact of the intervention on quality of life and allowing comparisons with other interventions for other diseases. The utilities were measured appropriately, from the patients in the trial.
Costs:
The perspective was stated and appropriate costs appear to have been included. The price year was reported and discounting was not necessary, given the 12-week follow-up. The resource use was appropriately derived from the participants in the clinical trial and the cost estimates were reported to have been from published studies. The description of the cost estimates was limited, reducing the transparency and generalisability of the cost analysis.
Analysis and results:
An incremental approach was used to combine the cost and outcome data, but the results for the two interventions were combined and compared with an alternative, which was not described. Uncertainty in the results was not sufficiently investigated. The results appear to be specific to the authors' setting and are unlikely to be transferable to other settings.
Concluding remarks:
The study was generally well reported, but there were some limitations in the methods, making the results uncertain.