When CE analysis is conducted, well-established methodology should be used and transparency should be ensured. CE thresholds are expected to emerge in many countries, driven by the need for transparent and consistent decision-making. Future thresholds will likely be higher in most high-income countries than currently cited rules of thumb.

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Results of this study support the validity of the SF-36 to document the health burden of arthritis and as a measure of generic health outcome for clinical trials of alternative treatments for osteoarthritis and rheumatoid arthritis patients.

ObjectiveTo determine the prevalence of obesity and its related comorbidities among patients being actively managed at a US academic medical centre, and to examine the frequency of a formal diagnosis of obesity, via International Classification of Diseases, Ninth Revision (ICD-9) documentation among patients with body mass index (BMI) ≥30 kg/m2.DesignThe electronic health record system at Cleveland Clinic was used to create a cross-sectional summary of actively managed patients meeting minimum primary care physician visit frequency requirements. Eligible patients were stratified by BMI categories, based on most recent weight and median of all recorded heights obtained on or before the index date of 1July 2015. Relationships between patient characteristics and BMI categories were tested.SettingA large US integrated health system.ResultsA total of 324 199 active patients with a recorded BMI were identified. There were 121 287 (37.4%) patients found to be overweight (BMI ≥25 and <29.9), 75 199 (23.2%) had BMI 30–34.9, 34 152 (10.5%) had BMI 35–39.9 and 25 137 (7.8%) had BMI ≥40. There was a higher prevalence of type 2 diabetes, pre-diabetes, hypertension and cardiovascular disease (P value<0.0001) within higher BMI compared with lower BMI categories. In patients with a BMI >30 (n=134 488), only 48% (64 056) had documentation of an obesity ICD-9 code. In those patients with a BMI >40, only 75% had an obesity ICD-9 code.ConclusionsThis cross-sectional summary from a large US integrated health system found that three out of every four patients had overweight or obesity based on BMI. Patients within higher BMI categories had a higher prevalence of comorbidities. Less than half of patients who were identified as having obesity according to BMI received a formal diagnosis via ICD-9 documentation. The disease of obesity is very prevalent yet underdiagnosed in our clinics. The under diagnosing of obesity may serve as an important barrier to treatment initiation.

poor fit to the model. These items included "getting in and out of the bath" and "going down stairs." Conclusion-The WOMAC generally satisfies the requirements of Rasch item response theory across all disorders studied, and is an appropriate measure of lower body function in OA, RA and fibromyalgia. Although some individual items do not fit well, it is not likely that removing such items would result in more than overall minimal diVerences, and it will be diYcult to remove traces of multidimensionality while keeping the central constructs of progressive lower body musculoskeletal abnormality intact. In addition, it is possible that a "purer", still more unidimensional instrument would be less useful in clinical trials and epidemiological studies by restricting the range of the scale. (Ann Rheum Dis 1999;58:563-568) Among the major determinants of health related quality of life in osteoarthritis of the knee or hip (OA) are pain and functional loss. The Western Ontario MacMaster (WOMAC) questionnaire was designed to measure these components by assessing 17 functional activities, five pain related activities, and two stiffness items.