Critical appraisal:Comay D, Blackhouse G, Goeree R, Armstrong D, Marshall JK 2007 2

From Clinical Guidelines Wiki

Critical Appraisal

Article being appraised

Comay D, Blackhouse G, Goeree R, Armstrong D, Marshall JK. Photodynamic therapy for Barrett's esophagus with high-grade dysplasia: a cost-effectiveness analysis. Can J Gastroenterol 2007 Apr;21(4):217-22 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17431509.


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
No
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 appropriate
The primary outcome measure(s) for the economic evaluation are clearly stated
Yes
Methods to value benefits are stated
Not clear
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
No response
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 appropriate
Details of any model used are given
Not clear
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
Not clear
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
Not appropriate
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
No
Relevant alternatives are compared
Yes
Incremental analysis is reported
Yes
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 confidence intervals. choice of treament benefits vary with cost estimates and willinginess to pay for a life year amounts. However all based on assumptions and modelling.
Relevance of evidence
6 Additional comments: cost effectiveness study comparing pdt to surgery to surveillance in model of 50 yo males with hgd.

sponsored by drug company that makes primer for pdt.
shows surveillance cheap but less life years, surg costs more but life years better qaly estimated at 80% and no change for PDT treatment.
Few assumptions and outcome is not definite more confirms need to discuss options, does not deal with risk of canceer at presentation of hgd.

Result of appraisal

Jutta's tick icon.png Included




Completed by

Associate Professor Bernard Mark Smithers


Jutta's tick icon.png This appraisal has been completed.


Article
Comay D, Blackhouse G, Goeree R, Armstrong D, Marshall JK. Photodynamic therapy for Barrett's esophagus with high-grade dysplasia: a cost-effectiveness analysis. Can J Gastroenterol 2007 Apr;21(4):217-22 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17431509.
Assigned to
User:Bernard.smithers
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


Section below only relevant for Cancer Council Project Officer

Edit appraisal assignment