Title: Global, Regional, and National Quality of Care Index of Cervical and Ovarian Cancer: A
Systematic Analysis for the Global Burden of Disease Study 1990-2019
Version: 1 Date: 17 Nov 2023
Reviewer's report:
The authors employed a Quality of Care Index (QCI) to assess health-system quality and
inequities in cervical and ovarian cancer.
In the abstract, some acronyms like "DALYs, YLLs, and YLDs" were used without explanation.
It would be helpful if the authors could provide more details on how the QCI was calculated,
perhaps by including codes or mathematical analyses in supplementary material.
In the background (line 65), the authors highlighted an increase in the incidence and prevalence
of both cervical and ovarian cancer. However, in the results (lines 149-150), they reported a
decrease in the incidence of cervical cancer. If there are discrepancies between these findings
and reference 2 (James SL, The Lancet. 2018), it would be valuable to discuss potential reasons,
including differences in dates. Addressing this discrepancy and exploring potential contributing
factors could enhance the clarity and reliability of the results.
For clarity, in each figure, the authors should specify the meaning of each acronym. For example,
instead of writing “Quality of Care Index for cervical...”, consider using “Quality of Care Index
(QCI) for cervical...”. Additionally, for consistency, the authors should adopt the same pattern
throughout. For example, in Figure 3, they write “quality of care index” in lowercase letters,
while in other figures, it is written in capital letters. Maintaining a consistent writing pattern
across all figures will enhance the overall visual and textual coherence of the manuscript.
In line 252, the phrase "and in a particular age group" lacks specificity. It would be beneficial
for the authors to clarify which particular age group is being referred to, providing more context
for the reader's understanding.
Similarly, in line 339, the term "other limitations" is vague. The authors should explicitly outline
what these additional limitations are.
In addition to addressing controversies regarding screening programs (line 270), I suggest
incorporating more information about successful cases, such as those in Australia and Finland.
Consider delving deeper into how prevalence and incidence may impact health systems,
particularly in low-income countries. Additionally, discuss the variations in health system access
(free, public) and cervical cancer prevention programs, especially in countries with similar SDI
but differing QCI (line 278).
Regarding age, the authors mentioned that, commonly, the elderly receive more conservative
treatments. However, this is also true for younger individuals, particularly those aiming to
preserve fertility, especially in women without children.
Additionally, while the authors delve into the effects of cervical cancer screening on QCI, it
is recommended to delve into common treatment approaches for cervical cancer. Discussing
variations between low- and high-income countries, as well as among different age groups, is
crucial, as these factors can substantially impact the overall quality of care.
In line 310, it is suggested to include the meaning of NSAID.