Critical appraisal:Shaheen NJ, Inadomi JM, Overholt BF, Sharma P 2004 2

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Critical Appraisal

Article being appraised

Shaheen NJ, Inadomi JM, Overholt BF, Sharma P. What is the best management strategy for high grade dysplasia in Barrett's oesophagus? A cost effectiveness analysis. Gut 2004 Dec;53(12):1736-44 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15542506.


Applicable clinical question

Key Facts

Study Design

health economic study

Number of Patients:

0


Includes an economic evaluation

yes

Evidence ratings

Level of evidence

III-3


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 clear
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
Not appropriate
Productivity changes (if included) are reported separately
No
The relevance of productivity changes to the study question is discussed
No
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
Yes
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
No
The discount rate(s) is stated
No
The choice of discount rate(s) is justified
No
An explanation is given if costs and benefits are not discounted
No
Details of statistical tests and confidence intervals are given for stochastic data
Yes
The approach to sensitivity analysis is given
Yes
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
No
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
4 Reason for decision: Not a large difference between the costs.
Relevance of evidence
3 Additional comments: Evidence to suport endoscopic therapy is more cost effective than resection. However in 2004 photodynamic therapy (PDT)assessed. Not used widely and now probably obsolete. However study relevant in that the newer endoscopic therapies are better with more complete removal and less morbidity. (This has never been tested in RCT). The otehr problem is the cost of the newer therpies may be a little more than PDT
Result of appraisal

Jutta's tick icon.png Included




Completed by

Associate Professor Bernard Mark Smithers


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Article
Shaheen NJ, Inadomi JM, Overholt BF, Sharma P. What is the best management strategy for high grade dysplasia in Barrett's oesophagus? A cost effectiveness analysis. Gut 2004 Dec;53(12):1736-44 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/15542506.
Assigned to
User:Bernard.smithers
Topic area
Guidelines:Barrett's
Clinical question
Form
Form:Critical appraisal


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