The intervention and control were adequately described, and their selection was relevant for the Japanese setting.
The estimate for the treatment effect was based on retrospective observational data. It is difficult to account for all potential confounding factors in such an analysis, and the authors highlighted this limitation. The propensity matching approach was appropriate for the data available, but it only addressed the known confounders. Mortality appears to have been an appropriate measure of benefit, but quality of life (morbidity) was also important and relevant to patients with acute pancreatitis.
Few details of the cost items, included in the analysis, were reported, so it is difficult to check whether the relevant resource use was recorded in the database and subsequently included in the analysis. The authors suggested that it was comprehensive, but did not support this by presenting the details. The resource use estimates and the prices used for those resources, all appear to be directly applicable to the Japanese setting. The unit costs for the resources were not reported, neither was the price year for the analysis.
Analysis and results:
The statistical analyses appear to have been appropriate for estimating the differences in the treatment effects and costs, as well as providing estimates of the statistical uncertainty. The results were adequately reported. This analysis was based on one clinical study, and the authors appropriately referred to existing clinical trial evidence for the effectiveness of gabexate mesylate. The authors identified relevant limitations to their analysis, such as the retrospective nature of the evidence, and the all-encompassing definition of the intervention (continuous intravenous or regional arterial administration, in various patients).
There was the possibility of bias in the clinical and cost estimates, given the nature of the evidence, but the analyses were appropriate and the authors' conclusions are reasonable.