Review for 10.1186/s12876-023-02793-5 (2023)

Title: ECONOMIC EVALUATIONS OF RADIOEMBOLIZATION WITH YTTRIUM-90
MICROSPHERES IN LIVER METASTASES OF COLORECTAL CANCER: A
SYSTEMATIC REVIEW
Version: 0 Date: 14 Mar 2023
Reviewer's report:
In the manuscript, “ECONOMIC EVALUATIONS OF RADIOEMBOLIZATION WITH
YTTRIUM-90 MICROSPHERES IN LIVER METASTASES OF COLORECTAL CANCER:
A SYSTEMATIC REVIEW”, Alonso et al. describe the transarterial radioembolization with
yttrium-90 (90Y-TARE) could be a cost-effective strategy for patients with liver metastases
from colorectal cancer (lmCRC), either as a monotherapy or in combination with a systemic
therapy. The authors used Preferred Reporting Items for Systematic Reviews and Meta-Analyses
(PRISMA) methodology to identify studies from search. Consolidated Health Economic
Evaluation Reporting Standards (CHEERS) checklist was used for quality assessment. To
overcome different currencies and reference years, the costs were converted to 2020 ($US PPP
costs). However, the number of studies is limited and skewed to the United Kingdom (U.K).
Major comments
1. For a broader audience, the authors explain the background of the method in the introduction
to make their paper acceptable. Therefore, the authors need to explain why the specific method
should be used.
2. CHEERS 2022 statement has been to replace CHEERS 2013. The authors need to update
Table 1 with the recent CHEERS checklist.
3. Even though all the other studies are done in the UK except Italy in Europe, the authors
converted the reported costs to euro and inflated them to 2022, and transformed them to U.S.
dollar for purchasing power parity factor (PPP). But there has been a huge change in the pound
sterling euro exchange rate over 2020. It should be considered that the value of the pound sterling
could be distorted. Could the authors explain the reason why you do not compare the cost of the
UK and the euro directly to dollars and then inflation in 2020 and demonstrate the results?
4. The authors report the costs of 90Y-TARE in different countries. Because the
pharmacoeconomics of the countries are different, the transferability assessment (e.g Welte
checklist) should be considered.
Minor comments
1. In table 3, the ICER and the ICRU column are labeled Euro (€) but the contents of UK studies
are showing the pound sterling symbol prior to costs. It is confusing whether these costs are
converted to Euro or still pound sterling. If it was converted, it going to be better to remove the
symbol because the original cost is showing the information.
2. In table 2, it would be helpful for readers to add abbreviations of outcomes.
3. To understand the studies, it would be better to add the number of participants in each study.
4. It would be useful to report the number of search results should be inserted per row in the
supplementary table.
5. The authors need to specify exclusion criteria in the method of the abstract.
6. There is no description of the abbreviation "ICUR" in the abstract. The author should write
the full name prior to using the abbreviation.
7. In the background, the sentence starting with "The ESMO" at line 67 includes "with" 3 times.
It might be better to change "the patients with lmCRC" to "lmCRC patients".