The selection of comparators was thorough and the usual screening in the authors’ setting was compared against alternative screening strategies. These interventions were described.
No systematic search of the literature was reported. The basic characteristics of the primary data sources (their population, follow-up, and design) were also not reported. This makes it difficult to objectively assess the validity of the clinical data. Life-years gained could show the major health outcome differences between the screening strategies. They also allow cross-disease comparisons to be made.
The authors stated that a societal perspective was adopted, but they did not clearly distinguish between health service, personal, and productivity costs. It was not clear that productivity costs were included. The unit costs were reported for most of the categories, but resource use was not, limiting the transparency of the analysis. The sources of the unit costs were not described, but their references were given. If these costs were at official prices, then a cost-to-charge ratio should have been used to reflect the costs from a societal perspective. The price year and discounting were appropriately reported.
Analysis and results:
The model was not described. An incremental cost-effectiveness analysis was appropriately performed. The issue of uncertainty was addressed, but this analysis and its results were not described in detail. The authors acknowledged, as a limitation, that a probabilistic analysis and the generation of cost-effectiveness acceptability curves would have been more appropriate and would have improved the reliability of their findings. The limits in the generalisability of the results to other settings were also highlighted.
The reporting was insufficient and the authors’ conclusions should be considered with caution.