Reviewer ’s report  
 
Title: Effectiveness, Benefit Harm and Cost Effectiveness of Colorectal Cancer Screening in  
Austria 
 
Version: 0 Date: 24 Aug 2019  
 
Reviewer: Giuseppe Losurdo  
 
Reviewer's report:  
 
In the present study John et al demonstrated by a Markov model that annua l FIT or 10 -yearly 
colonoscopy showed the best profile of effectiveness and harm/benefit balance in the setting of 
colorectal cancer (CRC) screening in an Austrian population. Main comments:  
 
 
1) Page 15 lines 257 -262: the definition of IHBR is quite hard to  understand for a 
gastroenterology audience without advanced epidemiology knowledge. Please reformulate this 
paragraph in order to improve the readability. A practical example may be beneficial.  
 
 
2) Table 5, third column reports twice "FIT is dominant". Wha t does it mean? That in all other 
cases the outcomes for FIT and colonoscopy are comparable?  
 
 
3) Page 25 lines 409 -411. To confirm this sentence, Authors should report how many positive 
FIT led to execution of how many colonoscopies, and then compare the nu mber of colonoscopies 
per 1000 people in FIT group with the 10 -yearly colonoscopy group. This detail is absent in the 
paper.  
 
 
4) Which was the polyp detection rate among the three groups?  
 
 
5) Page 26 lines 428 -430. Please explain this sentence. How could col onoscopy have a lower 
sensitivity (compared to what?) if it is considered as the gold standard for polyp detection? 
Moreover ref. 37 refers only to a conference proceeding.  
 
 
6) Finally, it is unclear whether Authors presented results only for the subjects w ith full 
adherence to protocol. Please explain. Additionally, if different rates of adherence were recorded, 
may the Authors correlate such variable with the main studied outcomes?  
 
 
 
 
Are the methods appropriate and well described ? 
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
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, f ees, 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 t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the futu re? 
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organizatio n that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
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 understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments 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 Acc ess 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 in cluded 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: Effectiveness, Benefit Harm and Cost Effectiveness of Colorectal Cancer Screening in  
Austria 
 
Version: 0 Date: 24 Aug 2019  
 
Reviewer: Giuseppe Losurdo  
 
Reviewer's report:  
 
In the present study John et al demonstrated by a Markov model that annua l FIT or 10 -yearly 
colonoscopy showed the best profile of effectiveness and harm/benefit balance in the setting of 
colorectal cancer (CRC) screening in an Austrian population. Main comments:  
 
 
1) Page 15 lines 257 -262: the definition of IHBR is quite hard to  understand for a 
gastroenterology audience without advanced epidemiology knowledge. Please reformulate this 
paragraph in order to improve the readability. A practical example may be beneficial.  
 
 
2) Table 5, third column reports twice "FIT is dominant". Wha t does it mean? That in all other 
cases the outcomes for FIT and colonoscopy are comparable?  
 
 
3) Page 25 lines 409 -411. To confirm this sentence, Authors should report how many positive 
FIT led to execution of how many colonoscopies, and then compare the nu mber of colonoscopies 
per 1000 people in FIT group with the 10 -yearly colonoscopy group. This detail is absent in the 
paper.  
 
 
4) Which was the polyp detection rate among the three groups?  
 
 
5) Page 26 lines 428 -430. Please explain this sentence. How could col onoscopy have a lower 
sensitivity (compared to what?) if it is considered as the gold standard for polyp detection? 
Moreover ref. 37 refers only to a conference proceeding.  
 
 
6) Finally, it is unclear whether Authors presented results only for the subjects w ith full 
adherence to protocol. Please explain. Additionally, if different rates of adherence were recorded, 
may the Authors correlate such variable with the main studied outcomes?  
 
 
 
 
Are the methods appropriate and well described ? 
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
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, f ees, 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 t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the futu re? 
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organizatio n that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
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 understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments 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 Acc ess 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 in cluded 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: Effectiveness, Benefit Harm and Cost Effectiveness of Colorectal Cancer Screening in  
Austria 
 
Version: 0 Date: 24 Aug 2019  
 
Reviewer: Giuseppe Losurdo  
 
Reviewer's report:  
 
In the present study John et al demonstrated by a Markov model that annua l FIT or 10 -yearly 
colonoscopy showed the best profile of effectiveness and harm/benefit balance in the setting of 
colorectal cancer (CRC) screening in an Austrian population. Main comments:  
 
 
1) Page 15 lines 257 -262: the definition of IHBR is quite hard to  understand for a 
gastroenterology audience without advanced epidemiology knowledge. Please reformulate this 
paragraph in order to improve the readability. A practical example may be beneficial.  
 
 
2) Table 5, third column reports twice "FIT is dominant". Wha t does it mean? That in all other 
cases the outcomes for FIT and colonoscopy are comparable?  
 
 
3) Page 25 lines 409 -411. To confirm this sentence, Authors should report how many positive 
FIT led to execution of how many colonoscopies, and then compare the nu mber of colonoscopies 
per 1000 people in FIT group with the 10 -yearly colonoscopy group. This detail is absent in the 
paper.  
 
 
4) Which was the polyp detection rate among the three groups?  
 
 
5) Page 26 lines 428 -430. Please explain this sentence. How could col onoscopy have a lower 
sensitivity (compared to what?) if it is considered as the gold standard for polyp detection? 
Moreover ref. 37 refers only to a conference proceeding.  
 
 
6) Finally, it is unclear whether Authors presented results only for the subjects w ith full 
adherence to protocol. Please explain. Additionally, if different rates of adherence were recorded, 
may the Authors correlate such variable with the main studied outcomes?  
 
 
 
 
Are the methods appropriate and well described ? 
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
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, f ees, 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 t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the futu re? 
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organizatio n that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
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 understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments 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 Acc ess 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 in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant