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E base case, at a willingness-to-pay of cad 50,000 per qaly, immediate cystectomy was cost-effective in 67% of simulations. It was dominant in younger patients (under 60 years), but in older patients (over 70 years) and those with more comorbidities, conservative therapy was the preferred strategy (dominant or cost-effective). cheap viagra At a willingness-to-pay threshold of cad 50,000 per ly gained the expected value of perfect information was cad 1,877 per patient and, at a threshold of cad 50,000 per qaly, it was cad 28,220 per patient. Authors' conclusions the authors concluded that immediate cystectomy was a cost-effective alternative to conservative therapy, except in older patients and in those with more comorbidities. viagra expiration safe Crd commentary interventions:the selection of the comparators was appropriate as they were two valid alternative treatments for patients with bladder cancer. lilly's viagra Effectiveness/benefits:the approach used to identify the relevant sources of data was not described and the characteristics of the data sources were not reported. This lack of information limits the possibility of objectively judging the validity of the clinical estimates, but the data were pooled, where possible, and extensive sensitivity analysis was conducted. buy viagra canada Appropriate benefit measures were used and they captured the impact of the disease on survival and quality of life, which are relevant dimensions of health for patients with bladder cancer. buy viagra cheap No details on the derivation of the utility values were provided and the data were not from patients with bladder cancer because data for these patients had not been published. buying viagra online safety Costs:the reporting of the economic analysis was also limited as only total cost categories were presented and not individual items and resource quantities. viagra online The data sources were reported and they reflected the setting. buy viagra Other aspects of the analysis, such as the price year and use of discounting were reported. Analysis and results:the costs and benefits of the two strategies were clearly reported and appropriately synthesised in an incremental analysis, which showed the superior profile of immediate cystectomy. Designed By