Interventions:
The rationale for the selection of the comparators was clear as the proposed intervention was compared against the traditional pattern of care at the authors’ hospital.
Effectiveness/benefits:
The analysis was based on a study design that was subject to some potential limitations, mainly due to the retrospective design. Allocation of procedures to the study groups was not randomised but depended on the availability of the brushless antiseptic. The authors pointed out that there was no difference in the types and relative duration of cases between the two surgical groups. This might have ensured the baseline comparability of the two interventions, but no other characteristics of the two groups compared were provided. Power calculations were not performed to ensure the adequateness of the study sample, but the large number of patients involved should have overcome this limitation. However, evidence came from a single hospital, which might not be representative of other institutions. Various measures of the immediate effect of the antiseptic on patients’ health were used, but they were disease-specific and would not allow comparisons to be made with the benefits of other health care interventions.
Costs:
The economic analysis used a very limited perspective and was restricted to the cost of the antiseptics. These costs were presumably from the hospital database. Cost estimates were treated deterministically and were not subjected to analysis of uncertainty. A short time-horizon was considered and costs of treating wound infections were not included. The price year was not mentioned, nor was the period during which the study took place, so reflation calculations in other time periods would not be possible.
Analysis and results:
The costs and benefits of the two strategies were not combined using cost-effectiveness ratios because a cost-consequences analysis was carried out. Sensitivity analyses were not carried out and uncertainty was not investigated. The results were clearly presented. The authors stated that the results of this study were in line with previous economic evaluations of Avagard in adult populations; they acknowledged that the risk of selection bias was the main limitation of the analysis. The study findings should be considered specific to the authors’ hospital and could not be transferred to other settings.
Concluding remarks:
The study had some methodological drawbacks mainly in the design of the clinical study and the lack of sensitivity analyses. Caution is required when interpreting the authors’ conclusions.