The two strategies were well described, including the catheter ablation procedure and devices used. The comparators might be relevant in other settings.
The evidence for the clinical effectiveness of the two options was from a single-centre observational study that might be open to bias from a lack of blind assessment and randomisation. The results of this clinical study were clearly and fully reported. The clinical effects were superior for minor bleeding complications, but this was access-site pain only and it affected few patients, making the differential significance tenuous. The authors noted that bleeding complications resulted in increased patient discomfort and morbidity; quality-adjusted life-years might have been more appropriate as a measure of benefit, to include this morbidity in the analysis.
The perspective was not stated, but a hospital perspective appears to have been taken. The resource types included medications and hospitalisations for catheter ablation, but the details of these resources were not described, making it unclear if all the relevant items were included. The price year was not stated and it was unclear if the costs were adjusted for inflation. The costs were from UK sources, but a currency conversion from UK pounds sterling to US dollars was not reported.
Analysis and results:
The health outcomes and costs were not combined into incremental cost-effectiveness ratios and a cost-consequences analysis was performed. Confidence intervals were provided, which allowed the statistical significance of the results to be determined, but sensitivity analyses would have allowed the impact of uncertainty in the data estimates on the final results to be assessed.
The methods and results were mostly clear and comprehensive, but the unclear quality of the data and some limitations in the analysis mean that the conclusions reached by the authors are uncertain.