Interventions:
The comparators were appropriately selected; conventional prophylaxis was compared against the proposed therapy, which was more effective, but also more expensive.
Effectiveness/benefits:
No systematic review was reported to identify the relevant sources of data. Most of the evidence was from fondaparinux trials and one trial directly compared fondaparinux with enoxaparin. Randomised trials are generally considered to be valid sources of evidence because of their sound methods and design, but few details were given and the methods used to combine their data were not clearly reported. The validity of the clinical analysis cannot therefore be fully assessed. Some data were appropriately from large Italian databases. Life-years were an appropriate benefit measure as they capture the impact of the interventions on the patients’ health.
Costs:
The cost categories and their sources were consistent with the perspective of the Italian National Health Service. No list of cost items was given and the costs were reported as category totals, for each health condition. This reduces the transparency and external validity of the study. The sources of costs were clearly presented and the use of a panel of experts to assess the resource use should have ensured that these data were representative of the Italian context. The price year and discounting were clearly presented.
Analysis and results:
The results were clearly presented, with both absolute and incremental findings reported. A synthesis of the costs and benefits was not required, given the superior economic and clinical profile of fondaparinux. The uncertainty was partly investigated, as a deterministic approach was used to consider the variations in only two types of input. The authors compared their results with those of other published economic evaluations, which were generally similar. This study improved on the earlier studies by assessing the costs and benefits over a longer time horizon. These results might be transferable to settings with similar costs and clinical patterns.
Concluding remarks:
The study was generally well reported, but had some limitations. The authors’ conclusions need to be corroborated by further studies.