Interventions:
The selection of the comparators was appropriate as they were relevant therapies for the patient population. A clear description of all strategies was provided.
Effectiveness/benefits:
The approach used to identify the clinical inputs was appropriate as the literature review included all relevant sources of data. The authors provided the key details of the methods and conduct of the review. The selection of RCTs enhanced the validity of the clinical data and the pooling methods were reported. In general, the clinical analysis appears to have been well carried out. The benefit measure was disease-specific and might not have been appropriate for capturing the global impact of the treatments on patients’ health. It is also not comparable with the benefits of other health care interventions and the threshold for the willingness-to-pay for a cured patient was not determined.
Costs:
The economic analysis was consistent with the perspective of the payer in terms of the types of costs and the sources of data. Most of the unit costs and quantities of resources (especially for drug consumption) were presented, which enhances the transparency of the economic analysis. The price year was not explicitly reported, but it appears, from the sources of unit costs, to have been 2008.
Analysis and results:
The results were clearly presented and both average and incremental cost-effectiveness ratios were calculated. The authors did not mention that because the vancomycin then linezolid option was dominated by vancomycin at home, the relevant incremental cost-effectiveness ratio was the $9,488 for linezolid versus vancomycin at home. The issue of uncertainty was well investigated using various approaches, and the findings were satisfactorily presented and discussed. Details of the decision model were appropriately reported. The main limitation of the analysis was the fact that, as no willingness-to-pay threshold for a cured patient was available, it is hard to assess which treatment should be considered to be the most cost-effective. The authors stated that some assumptions were made, such as the exclusion of adverse events, but these should not have had a strong impact on the results.
Concluding remarks:
: The study was well conducted and the authors’ conclusions appear to be valid.