The author justified the selection of the comparators; breast cancer and vascular events have different pathologies that affect different individuals in different ways, but the proposed education programme was compared against a well-established screening programme.
The clinical inputs were from published evidence, which was not described, limiting the possibility of judging their validity. The author stated that Welsh data were used, wherever possible. Ranges of values were reported, but it was unclear whether the clinical inputs were varied in a sensitivity analysis. The author justified the use of lives saved as the summary benefit measure because it was a common endpoint for the two different interventions, but morbidity and adverse events might have been important for the assessment of the benefits and risks of aspirin.
The economic analysis was not extensively presented. The perspective was not stated, but appears to have been that of the UK NHS. The time horizon, a breakdown of costs, the unit costs, and the quantities of resources were not reported. The data sources were referenced or stated, but were not described. The price year was not reported, hindering reflation exercises. Ranges of values for the cost estimates were reported, but no sensitivity analysis was reported.
Analysis and results:
The results were clearly reported. Average cost-effectiveness ratios were calculated. The uncertainty was not explicitly investigated, but ranges of values from the literature were considered. The results appear to be specific to Wales and their transferability was not discussed. It was unclear whether a model was used to estimate the cost-effectiveness for the two interventions. In general, the information on the data sources and methods was limited.
This study used a simplified cost-effectiveness framework, with some methodological limitations, and some sources of evidence were not described. Caution is required when interpreting the author’s conclusions.