Interventions:
The interventions were clearly reported including the dosage. The study was thorough in its coverage of alternative interventions, including current practice in its setting.
Effectiveness/benefits:
The effectiveness data were derived from two clinically comparable RCTs. However, the selection of these studies was not justified. The full details of the trials were not reported in this paper; and a full assessment of their internal validity was therefore not possible. Life-years gained is a useful measure of benefit given the risk of death from the disease progression. However, the relative importance of quality of life outcomes should be considered.
Costs:
The costs appeared to reflect the perspective stated. With the exception of some costs and quantities which were not reported separately, most of the cost data were adequately reported, along with adjustments, including discounting and the price year. An extensive probabilistic sensitivity analysis around the cost estimates and one-way sensitivity analysis around the discount rate demonstrated that these estimates were robust. They were also appropriate for the study setting.
Analysis and results:
The model structure, relevant details and modelling assumptions were clearly reported. The authors conducted an incremental analysis and the results were adequately presented. The methods used throughout the economic evaluation and the sensitivity analysis were adequately reported. An extensive sensitivity analysis was conducted on modelling parameters, which enhanced the generalisability of the findings and showed the robustness of the results. The authors outlined a number of possible limitations to the study and their impact on the results.
Concluding remarks:
Apart from a couple of methodological uncertainties, the authors presented a fairly transparent analysis and their conclusions appear to be reasonable.