In this study, planned early initiation of dialysis in patients with stage V chronic kidney disease was not associated with an improvement in survival or clinical outcomes. (Funded by the National Health and Medical Research Council of Australia and others; Australian New Zealand Clinical Trials Registry number, 12609000266268.)

OBJECTIVE To estimate the cost-effectiveness of surgically induced weight loss relative to conventional therapy for the management of recently diagnosed type 2 diabetes in class I/II obese patients. RESEARCH DESIGN AND METHODS This study builds on a within-trial cost-efficacy analysis. The analysis compares the lifetime costs and quality-adjusted life-years (QALYs) between the two intervention groups. Intervention costs were extrapolated based on observed resource utilization during the trial. The proportion of patients in each intervention group with remission of diabetes at 2 years was the same as that observed in the trial. Health care costs for patients with type 2 diabetes and outcome variables required to derive estimates of QALYs were sourced from published literature. A health care system perspective was adopted. Costs and outcomes were discounted annually at 3%. Costs are presented in 2006 Australian dollars (AUD) (currency exchange: 1 AUD = 0.74 USD). RESULTS The mean number of years in diabetes remission over a lifetime was 11.4 for surgical therapy patients and 2.1 for conventional therapy patients. Over the remainder of their lifetime, surgical and conventional therapy patients lived 15.7 and 14.5 discounted QALYs, respectively. The mean discounted lifetime costs were 98,900 AUD per surgical therapy patient and 101,400 AUD per conventional therapy patient. Relative to conventional therapy, surgically induced weight loss was associated with a mean health care saving of 2,400 AUD and 1.2 additional QALYs per patient. CONCLUSIONS Surgically induced weight loss is a dominant intervention (it both saves health care costs and generates health benefits) for managing recently diagnosed type 2 diabetes in class I/II obese patients in Australia.

Research in context Evidence before this study A systematic review of chlamydia screening interventions identified six RCTs published up to the 14 th February 2016, four of which investigated the effect on the incidence of PID of a single offer of a chlamydia screening test and two which investigated the effect of multiple rounds of chlamydia screening on chlamydia prevalence. In a meta-analysis, the incidence of PID was lower in intervention than control groups (risk ratio, RR 0•68; 95%CI 0•49 to 0•94; I 2 =8%). However, methodological limitations of the trials could have resulted in an overestimation of the protective effects of a single chlamydia screening test. A cluster-RCT in women and men in the general population in the Netherlands found no change in chlamydia positivity among those tested after three rounds of screening (RR 0•96, 95% CI 0•84 to 1•09). However, screening uptake was low, with only 16% screened in the first round, falling to 10% in the third round. A cluster RCT of a multifaceted intervention that included syndromic management for sexually transmitted infections (STIs) among young adults in the community and STI screening in female sex workers in Peru found no difference in chlamydia prevalence after four years among young adults but in secondary analyses, found a reduction among female sex workers (adjusted RR 0•72; 95% CI 0•54 to 0•98). None of the trials investigated the impact of multiple rounds of testing on both chlamydia prevalence and the incidence of PID. We searched PubMed from January 1 2016 to February 28 2018 with the terms "chlamydia" and ("randomised controlled trial" or "randomised clinical trial" or "trial" or "randomly") and restricted the search to clinical trials in English only. No further completed trials were identified.

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