Interventions:
The rationale for the selection of the comparators was clear as the current pattern of care in the authors’ setting, which was Pap screening, was compared with the proposed intervention, which was cervical cancer vaccination. These are likely to represent relevant comparators in other settings.
Effectiveness/benefits:
The approach used to identify the primary sources of data was not reported and they were presumably already known to the authors. No information on the methods and other characteristics of data sources was provided and the authors did not describe the approach used to select the base-case estimate, where multiple studies were available. This limits the possibility of judging the validity of the clinical evidence, despite the extensive sensitivity analyses. Some assumptions were needed and these were investigated in alternative scenarios. The authors pointed out that Canadian data were used wherever possible. The benefit measure was appropriately selected as QALYs capture the impact of cancer on both survival and quality of life, but the method of derivation of the utility values was not reported.
Costs:
The economic analysis was consistent with the viewpoint in terms of the cost categories, but the limited reporting of the data sources was not transparent makes it difficult to replicate the analysis in other settings. Treatment costs were presented as total categories and were not broken down in individual items. The price year and the use of discounting were reported. The cost estimates were treated deterministically, but they were varied in the sensitivity analysis.
Analysis and results:
The analytic approach was appropriate and the results were clearly presented and discussed. The issue of uncertainty was partly investigated in a deterministic analysis. A multivariate analysis was also carried out to generate best- and worst-case scenarios, which produced wide ranges of results. Several alternative scenarios were considered. The authors stated that their model was widely validated and was adapted for the Canadian setting. A diagram of the model and its basic transition patterns were given. The authors stated that their findings were similar to those of other published economic evaluations.
Concluding remarks:
The data sources were not fully reported, but the valid methods enhance the reliability of the authors’ conclusions.