Critical appraisal:Ofman JJ, Lewin K, Ramers C, Ippoliti A, Lieberman D, Weinstein W 2000

Critical Appraisal

Article being appraised

Ofman JJ, Lewin K, Ramers C, Ippoliti A, Lieberman D, Weinstein W. The economic impact of the diagnosis of dysplasia in Barrett's esophagus. Am J Gastroenterol 2000 Oct;95(10):2946-52 Available from: http://www.ncbi.nlm.nih.gov/pubmed/11051373.

Applicable clinical question

How frequently should patients with BO undergo endoscopy?

Key Facts

Study Design

health economic study

Number of Patients:

95

Includes an economic evaluation

yes

Evidence ratings

Show/Hide Risk of bias assessment

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

Yes

The rationale for choosing alternative programmes or interventions compared is stated

Yes

The alternatives being compared are clearly described

Yes

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)

Yes

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

Yes

Details of the subjects from whom valuations were obtained were given

Yes

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

Yes

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

No

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

No

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

No

The choice of variables for sensitivity analysis is justified

No

The range over which the variables are varied is justified

No

Relevant alternatives are compared

Yes

Incremental analysis is reported

No

Major outcomes are presented in a desegregated as well as aggregated form

Yes

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: 28–61% of endoscopies in Barrett’s surveillance programs due to transient dysplasia. More frequent surveillance in cohort would cost $509,549 over 10 years. Endoscopy workload and costs of surveillance could be substantially reduced if patients with transient positive diagnoses of dysplasia reverted to usual surveillance after two negative examinations.

Relevance of evidence

1	Additional comments: Study examining the economic implications of different surveillance strategies in those with transient dysplasia detected during Barrett's surveillance.

Result of appraisal

Included