Reviewer ’s report  
 
Title: Micro -costing analysis of guideline -based treatment by direct -acting agents: the real -life 
case of hepatitis C management in Brazil  
 
Version: 0 Date: 12 May 2017  
 
Reviewer: William Wong  
 
Reviewer's report:  
 
Summary:  
This manuscript performs a micro -costing study on  
1) The use of transient elastography for liver fibrosis assessment and;  
2) Treatment for chc using direct acting agents (DAA)  
Based on the costing studies, the authors claim that the treatment using TE+ DAA may be cost -
saving in comparison to use traditional biopsy + PR as treatment alternative.  
 
Comments:  
The paper is well written in general, however, the following information  should be included in 
the manuscript:  
1. Cohort information is missing. A cohort definition need to be provided in the method section 
when compare with interventions.  For example, author should stated that the cost reported 
in here is based on CHC patie nt with >=F3 and G1 only.  
2. Strategies definition is missing. The strategies (interventions) that is going to compared is 
not listed clearly in the method section.  A list of interventions should be discussed in the 
method section. Reader can only find th is information in Table 3 now.  
3. Inclusion of opportunity cost. When performing micro -costing on transient elastography for 
liver fibrosis assessment, opportunity cost was included in the calculation. However, when 
performing micro -costing on treatment, o pportunity cost was not included.  This make an in -
balance setting in the costing study. There are opportunity costs associated with treatment as 
well, particular for the PR -based DAA. Suggested to perform and report separately on 1) 
calculation without op portunity cost; and 2) calculation with opportunity cost.  
4. Title may be misleading.  The micro -costing study was performed to calculate the cost and 
SVR as outcomes in a very short time horizon. No additional follow -up data was used or 
simulated.  By loo king at the short -term results based mainly on the cost and short term 
outcome and concluded that it is cost -saving may not be appropriate. I would add this as a 
majority limitation in the discussion section. Also suggested to change the title of the 
manus cript accordingly.   
The quality of the manuscript would be much improved if the authors revise and address the 
issues according to the above suggestions.  
Are the methods appropriate and well described?  
If not, please specify what is r equired in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either  now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents re lating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing intere sts? 
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any att achments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Micro -costing analysis of guideline -based treatment by direct -acting agents: the real -life 
case of hepatitis C management in Brazil  
 
Version: 0 Date: 12 May 2017  
 
Reviewer: William Wong  
 
Reviewer's report:  
 
Summary:  
This manuscript performs a micro -costing study on  
1) The use of transient elastography for liver fibrosis assessment and;  
2) Treatment for chc using direct acting agents (DAA)  
Based on the costing studies, the authors claim that the treatment using TE+ DAA may be cost -
saving in comparison to use traditional biopsy + PR as treatment alternative.  
 
Comments:  
The paper is well written in general, however, the following information  should be included in 
the manuscript:  
1. Cohort information is missing. A cohort definition need to be provided in the method section 
when compare with interventions.  For example, author should stated that the cost reported 
in here is based on CHC patie nt with >=F3 and G1 only.  
2. Strategies definition is missing. The strategies (interventions) that is going to compared is 
not listed clearly in the method section.  A list of interventions should be discussed in the 
method section. Reader can only find th is information in Table 3 now.  
3. Inclusion of opportunity cost. When performing micro -costing on transient elastography for 
liver fibrosis assessment, opportunity cost was included in the calculation. However, when 
performing micro -costing on treatment, o pportunity cost was not included.  This make an in -
balance setting in the costing study. There are opportunity costs associated with treatment as 
well, particular for the PR -based DAA. Suggested to perform and report separately on 1) 
calculation without op portunity cost; and 2) calculation with opportunity cost.  
4. Title may be misleading.  The micro -costing study was performed to calculate the cost and 
SVR as outcomes in a very short time horizon. No additional follow -up data was used or 
simulated.  By loo king at the short -term results based mainly on the cost and short term 
outcome and concluded that it is cost -saving may not be appropriate. I would add this as a 
majority limitation in the discussion section. Also suggested to change the title of the 
manus cript accordingly.   
The quality of the manuscript would be much improved if the authors revise and address the 
issues according to the above suggestions.  
Are the methods appropriate and well described?  
If not, please specify what is r equired in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either  now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents re lating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing intere sts? 
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any att achments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Micro -costing analysis of guideline -based treatment by direct -acting agents: the real -life 
case of hepatitis C management in Brazil  
 
Version: 0 Date: 12 May 2017  
 
Reviewer: William Wong  
 
Reviewer's report:  
 
Summary:  
This manuscript performs a micro -costing study on  
1) The use of transient elastography for liver fibrosis assessment and;  
2) Treatment for chc using direct acting agents (DAA)  
Based on the costing studies, the authors claim that the treatment using TE+ DAA may be cost -
saving in comparison to use traditional biopsy + PR as treatment alternative.  
 
Comments:  
The paper is well written in general, however, the following information  should be included in 
the manuscript:  
1. Cohort information is missing. A cohort definition need to be provided in the method section 
when compare with interventions.  For example, author should stated that the cost reported 
in here is based on CHC patie nt with >=F3 and G1 only.  
2. Strategies definition is missing. The strategies (interventions) that is going to compared is 
not listed clearly in the method section.  A list of interventions should be discussed in the 
method section. Reader can only find th is information in Table 3 now.  
3. Inclusion of opportunity cost. When performing micro -costing on transient elastography for 
liver fibrosis assessment, opportunity cost was included in the calculation. However, when 
performing micro -costing on treatment, o pportunity cost was not included.  This make an in -
balance setting in the costing study. There are opportunity costs associated with treatment as 
well, particular for the PR -based DAA. Suggested to perform and report separately on 1) 
calculation without op portunity cost; and 2) calculation with opportunity cost.  
4. Title may be misleading.  The micro -costing study was performed to calculate the cost and 
SVR as outcomes in a very short time horizon. No additional follow -up data was used or 
simulated.  By loo king at the short -term results based mainly on the cost and short term 
outcome and concluded that it is cost -saving may not be appropriate. I would add this as a 
majority limitation in the discussion section. Also suggested to change the title of the 
manus cript accordingly.   
The quality of the manuscript would be much improved if the authors revise and address the 
issues according to the above suggestions.  
Are the methods appropriate and well described?  
If not, please specify what is r equired in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either  now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents re lating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing intere sts? 
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any att achments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant