Interventions:
The rationale for the selection of the comparators was clear as the proposed procedure was added to the conventional diagnostic management of patients with suspected non-small cell lung cancer.
Effectiveness/benefits:
The clinical analysis was based on a prospective cohort study, which is considered to be a valid source of evidence, but a randomised design would have been more appropriate. The authors provided information on the patient selection process and some characteristics of the patient sample. They did not justify the size of the sample, but it appears to have been large enough to detect differences in accuracy between the diagnostic procedures. The evidence came from a single academic institution, which might not be representative of other medical centres in Italy, especially in terms of the experience of health care professionals in performing the diagnostic evaluation. These issues should be considered when assessing the validity of the clinical estimates.
Costs:
The analysis of costs was not satisfactorily presented. The authors did not explicitly report the economic viewpoint and they did not provide a detailed breakdown of cost items, only presenting macro-categories. The sources of costs were not reported and the price year was not stated. These issues tend to limit the transparency of the economic analysis. The cost estimates were treated deterministically and they were not statistically assessed.
Analysis and results:
The analysis was restricted to a cost-consequences framework, which did not allow a synthesis of the costs and benefits, but the better outcomes and lower costs associated with PET did not require a formal cost-effectiveness analysis. The issue of uncertainty was not investigated and the authors did not address the issue of transferability of the results between settings. They did not acknowledge any limitations of their analysis.
Concluding remarks:
The study had some methodological limitations that might affect the validity of the authors’ conclusions.