The three interventions investigated were reported in detail. In addition, an explicit justification was given for using surgical interventions as the comparator: they represented current practice in the authors’ settings.
Although the authors reported that an extensive review of the literature was performed, no further details of either the review or the studies identified were reported. Consequently, it is not possible to determine whether all the available evidence was included. The authors did, however, report the base-case values employed for each model parameter and the sources on which they were based.
The perspective adopted in the economic analysis was clear, and all the relevant major cost categories appear to have been included. The authors appropriately reported the sources of the cost data, and provided cost estimates for each parameter used in the model. In addition, the time horizon, price year and currency used were all adequately reported.
Analysis and results:
Appropriate details of the model were reported, although there was no graphical representation of the model itself. A 6-month time horizon was used in the model. The authors reported that a longer time horizon was unlikely to alter the long-term mortality and morbidity, but a longer timeframe would have enabled the authors to estimate life expectancy and any other unexpected outcomes. Uncertainty in the model was evaluated using one- and two-way sensitivity analyses. Although these methods go some way in exploring uncertainty in the model results, a probabilistic sensitivity analysis would be a more thorough way of capturing overall model uncertainty. The limitations of the study were adequately reported.
The quality of the study methodology was satisfactory and the results were reported in full. However, only brief details of the review of the literature, from which the effectiveness parameters were obtained, were reported. The authors’ conclusions appear appropriate given the scope of the study.