Table A4:

Applicability of the Included Economic Study—Ravikumar et al, 2017⁵⁴

Question	Response
Is the study population similar to the question?	Partially. The study evaluated people with medication-resistant essential tremor eligible for surgical treatment, but did not consider people unsuitable for surgical treatment.
Are the interventions similar to the question?	Partially. The study excluded radiofrequency thalamotomy in the main analysis; the estimated cost was included only in the appendix.
Is the health care system in which the study was conducted sufficiently similar to the current Ontario context?	No. U.S. societal perspective.
Was/were the perspective(s) clearly stated, and what were they?	Yes. U.S. societal perspective.
Are estimates of relative treatment effect from the best available sources?	Uncertain, since nearly all included reports are uncontrolled observational studies, and a detailed assessment of the quality of each study is not available.
Are all future costs and outcomes discounted? (If yes, at what rate?)	Unclear, as the publication did not report the model time horizon.
Is the value of health effects expressed in terms of quality-adjusted life-years?	Yes, although how utility was derived was not clearly reported.
Are costs and outcomes from other sectors fully and appropriately measured and valued?	No. The study appears to include only direct medical costs, although the authors stated they were using a societal perspective.
Overall judgment	Partially applicable