The real-world cost-effectiveness of bariatric surgery for the treatment of severe obesity: a cost-utility analysis.

BACKGROUND: Severe obesity is associated with adverse health outcomes and increased risk of death. This study evaluates the real-world cost-utility of therapy for severe obesity, from the publicly funded health care system and societal perspectives. METHODS: We conducted a cost-utility analysis using primary data from a prospective observational cohort of adults living with severe obesity (BMI ≥ 35 kg/m2 and a major medical comorbidity or BMI ≥ 40 kg/m2) who were enrolled in a regional obesity program over 2 years. We extrapolated 10-year and lifetime Markov models, validated and supplemented with literature sources, to compare medical, surgical and standard care therapies. We performed deterministic and probabilistic sensitivity analyses. RESULTS: The cohort included 500 adults living with severe obesity, 150 of whom received laparoscopic surgical therapy. From a publicly funded health system perspective, at 2 years, surgical therapy had an incremental cost-effectiveness ratio (ICER) of $54 456 per quality-adjusted life-year (QALY) compared with standard care therapy. Over a lifetime, it had an ICER of $14 056 per QALY. From the societal perspective, at 2 years, surgical therapy had an ICER of $340 per QALY; over a lifetime, it was the dominant option. The results were robust to sensitivity analysis. INTERPRETATION: From a public health care perspective, surgery for severe obesity is cost effective, and when approached from a societal perspective, it becomes cost saving. Real-world data support using surgical therapy for severe obesity, and our results contribute to the health economic and clinical literature with regard to a robust analysis from a societal perspective.

Risk of bias assessment of clinical trials published in iberoamerican urological journals / Evaluación del riesgo de sesgo en los ensayos clínicos publicados en revistas urológicas iberoamericanas

OBJECTIVES: To assess the risk of bias of clinical trials published in iberoamerican indexed journals from January 1, 2008 to December 31, 2012. METHODS: We performed a descriptive study based on the clinical trials published from January 1st 2008 to December 31st 2012 in the iberoamerican urological journals. We assessed the risk of bias by the Cochrane tool. We used descriptive statistics in Stata 13 and Revman 5.2 to create the risk of bias graphs within and across studies. RESULTS: We identified 41 clinical trials: 21 trials in the International Brazilian Journal of Urology, seven trials in Actas Urológicas Españolas, six trials in Archivos Españoles de Urología, two trials in the Boletin Mexicano de Urología, four trials in Revista Mexicana de Urología and one trial in Revista Urología Colombiana. Most of these trials had unclear risk for the generation of the randomization (selection bias), the allocation concealment (selection bias) and the blinding (performance and detection). There was low risk of bias for incomplete results data (Attrition bias) and selective notification (notification bias). High risk of bias was found in other possible sources of bias, mainly because of low sample size. CONCLUSIONS: Based on the Cochrane risk of bias tool assessment, most of the published trials do not accomplish an adequate description of the methods. We should also be aware that most of the trials lack an adequate sample size calculation that limits the power of these trials. We recommend better description of the methods for randomization, and increasing the sample size to improve the quality of the trials published in urologic iberoamerican journals

OBJETIVO: Evaluar el riesgo de sesgo en los ensayos clínicos publicados en revistas iberoamericanas indexadas desde el 1 de enero del 2008 al 31 de Diciembre del 2012. MÉTODOS: Realizamos un estudio descriptivo basado en los ensayos clínicos publicados en las revistas urológicas iberoamericanas desde el 1 de Enero del 2008 y el 31 de diciembre del 2012. Evaluamos el riesgo de sesgo mediante la herramienta Cochrane. Utilizamos estadísticas descriptivas en Stata 13 y Revman 5.2 para crear gráficas del riesgo de sesgo dentro de los estudios y entre ellos. RESULTADOS: Identificamos 41 ensayos clínicos: 21 ensayos en el International Brazilian Journal of Urology, siete ensayos en Actas Urólogicas Españolas, seis ensayos en Archivos Españoles de Urología, dos en el Boletín Mexicano de Urología, cuatro en la Revista Mexicana de Urología y un ensayo en la Revista Urología colombiana. La mayoría de estos ensayos presentan un riesgo confuso para la generación de la aleatorización (sesgo de selección), la ocultación de la asignación (sesgo de selección) y el enmascaramiento (ejecución y detección). Había un bajo riesgo de sesgo para datos de resultados incompletos (sesgo de abandono) y de notificación selectiva (sesgo de notificación). El alto riesgo de sesgo se encontró en otras posibles fuentes de sesgo, principalmente debido a tamaño muestral bajo. CONCLUSIONES: Basándose en la herramienta Cochrane de evaluación del riesgo de sesgo, la mayoría de los ensayos publicados no llevan a cabo una adecuada descripción de los métodos. También debemos ser conscientes de que la mayoría de los ensayos carecen de un cálculo del tamaño muestral adecuado lo que limita su poder. Recomendamos una mejor descripción de los métodos de asignación aleatoria y aumentar el tamaño muestral para mejorar la calidad de los ensayos publicados en las revistas urológicas iberoamericanas

[PhD theses on gerontological topics in Russia 1995-2012: scientometric analysis].

The paper presents a scientometric analysis of PhD theses on gerontological topics in Russian humanities (excluding economics) for the period from 1995 to 2012. During this period, 253 PhD theses (238 of "candidate dissertations," and 15 of "doctoral dissertations") were defended in Russia. Almost half of them were defended during the boom years (2005-2006; 2009-2010). The number of theses defended in the 2000-s has increased significantly compared to the second half of 1990-s. However for gerontological PhD-s overall as a percentage of all theses defended in Russian humanities, the number hardly changed and remained small (less than 0.3%). The leading discipline in the study of aging (within the humanities) is sociology accounting for more than a third of all defended theses. Though the theses were defended in 48 cities, more than half of them were defended in 3 cities, which are Moscow, St. Petersburg and Saratov. Thematic analysis showed that the leading position was occupied by two topics: "the elderly and the state" (42%) and "(re)socialization/adaptation of the elderly" (25%). 14% of the works are devoted to intergenerational relations and social status of the elderly. Other topics (old man/woman's personality, self-perceptions of aging, violence and crime against the elderly, loneliness, discrimination, etc.) are presented by very few studies.