Comparator selection was appropriate as the proposed intervention was compared to usual care. The programme considered was implemented in real practice in USA.
The impact of patient navigation programmes in reducing the time from abnormal screening to diagnostic resolution was based on real estimates from the programme in three large sites in USA and this appeared to be a valid source. The impact of standard care was based on United States guidelines that might not fully reflect the real clinical results (although based on large databases). Sensitivity analysis was made on this parameter.
The benefit measure was specific to the study objective and the strategies compared and did not enable comparisons with other diseases.
Types of costs included in the analysis and their sources were consistent with the perspective of the study. The authors pointed out that costs of capital items and start-up costs of the programme were not considered as they were incurred before the time period of the cost analysis. Costs were presented as macro-categories and were not broken down in individual items. In effect, details of unit costs and quantities of resources used were not given. Programme costs were taken from the real implementation of patient navigation programmes in three sites. Cancer costs were taken from health maintenance organisations. These were representative of the authors’ setting. The price year was reported appropriately.
Analysis and results:
Study results were reported clearly for the base case scenarios and the ranges of estimated costs and benefits. The authors pointed out that the time horizon was appropriate to capture the efficacy of the programmes under examination. A deterministic approach was used to investigate the issue of uncertainty and key findings were reported. Study findings should be considered specific to the USA setting and cannot be transferred to other countries.
The analysis used a conventional cost-effectiveness framework that relied on data derived from the implementation of the patient navigation programmes in three hospitals. The authors’ conclusions appear valid.