Critical appraisal:Boger PC, Turner D, Roderick P, Patel P 2010 3

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Critical Appraisal

Article being appraised

Boger PC, Turner D, Roderick P, Patel P. A UK-based cost-utility analysis of radiofrequency ablation or oesophagectomy for the management of high-grade dysplasia in Barrett's oesophagus. Aliment Pharmacol Ther 2010 Dec;32(11-12):1332-42 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21050235.


Applicable clinical question

Key Facts

Study Design

health economic study

Number of Patients:

Not applicable


Includes an economic evaluation

yes

Evidence ratings

Level of evidence

IV


Risk of bias assessment: health economic study

Study design
The research question is stated
Yes
The economic importance of the research question is stated
Yes
The viewpoint(s) of the analysis are clearly stated and justified
Not clear
The rationale for choosing alternative programmes or interventions compared is stated
Yes
The alternatives being compared are clearly described
Not clear
The form of economic evaluation used is stated
Yes
The choice of form of economic evaluation is justified in relation to the questions addressed
Yes
Data collection
The source(s) of effectiveness estimates used are stated
Yes
Details of the design and results of effectiveness study are given (if based on a single study)
Not appropriate
Details of the methods of synthesis or meta-analysis of estimates are given (if based on a synthesis of a number of effectiveness studies)
Not clear
The primary outcome measure(s) for the economic evaluation are clearly stated
Yes
Methods to value benefits are stated
No response
Details of the subjects from whom valuations were obtained were given
Not appropriate
Productivity changes (if included) are reported separately
Not appropriate
The relevance of productivity changes to the study question is discussed
Not appropriate
Quantities of resource use are reported separately from their unit costs
Not clear
Methods for the estimation of quantities and unit costs are described
Yes
Currency and price data are recorded
Yes
Details of currency of price adjustments for inflation or currency conversion are given
Not clear
Details of any model used are given
Yes
The choice of model used and the key parameters on which it is based are justified
Yes
Analysis and interpretation of results
Time horizon of costs and benefits is stated
Yes
The discount rate(s) is stated
Yes
The choice of discount rate(s) is justified
Yes
An explanation is given if costs and benefits are not discounted
Not appropriate
Details of statistical tests and confidence intervals are given for stochastic data
No
The approach to sensitivity analysis is given
Not clear
The choice of variables for sensitivity analysis is justified
Yes
The range over which the variables are varied is justified
Yes
Relevant alternatives are compared
Yes
Incremental analysis is reported
Not clear
Major outcomes are presented in a desegregated as well as aggregated form
Not clear
The answer to the study question is given
Yes
Conclusions follow from the data reported
Yes
Conclusions are accompanied by the appropriate caveats
Yes
Size of effect
5 Reason for decision: no confidenec interval given, effect small and would vary with cost of rfa and followup procedures
Relevance of evidence
1 Additional comments: cost effectiveness study on hypothetical group with HGD comparing immediate surgery versus RFA then surg if recurrence. result relevant. The outcome states that rfa then surg gives 0.4 extrat QALY and costs 1902 sterling less. Lot of assumptions in datset limit accuracy no true nhs copst of rfa at time of article therfore estimated only, will vary in cost with type of endoscopic follow up and estimated only 4 seessions for rfa treatment only.
Result of appraisal

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Completed by

Associate Professor Bernard Mark Smithers


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Article
Boger PC, Turner D, Roderick P, Patel P. A UK-based cost-utility analysis of radiofrequency ablation or oesophagectomy for the management of high-grade dysplasia in Barrett's oesophagus. Aliment Pharmacol Ther 2010 Dec;32(11-12):1332-42 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21050235.
Assigned to
User:Bernard.smithers
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


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