The rationale for the choice of the interventions was reported and it seems that the authors used the comparator that was available in their setting.
The sample seems to have been an appropriate representation of the wider population. The participants were randomly selected and invited to participate, but the details of this random selection were not reported. The exclusion criteria were clearly reported and it appears that the use of bone mineral density to assess the concordance was appropriate, as it was the gold standard procedure. It was not clear if there were any withdrawals or exclusions during the study. The number of fractures prevented was a clinically meaningful, but disease-specific measure of benefit, which limits the possibility of cross-disease comparisons.
The perspective was not reported and the reporting of the costs lacked detail. They were given as total categories, which makes it hard to know which items were included in each category. The unit costs and resource quantities were not reported separately, limiting the transparency of the analysis. The OSTA intervention was assumed to have no cost, which was unrealistic. The price year was not reported, hindering future reflation exercises. In general, the cost reporting lacked transparency and was poorly conducted and reported. This might be due to the main focus of the paper being the clinical analysis.
Analysis and results:
The costs and benefits were combined in a cost-effectiveness ratio. The issue of uncertainty was addressed, in a deterministic analysis of selected effectiveness parameters. The uncertainty around the cost estimates was not investigated, limiting the generalisability of these findings to other settings. This was acknowledged by the authors as a limitation to their study. They also briefly mentioned some other limitations, which mainly related to the validity of the effectiveness and cost inputs.
The study had several limitations and the costs were poorly reported. The economic analysis was not the main focus of the paper, which might explain these limitations. The authors' conclusions should be treated with caution.