Cost-utility and cost-effectiveness analyses of a long-term, high-intensity exercise program compared with conventional physical therapy in patients with rheumatoid arthritis

2005 ◽  
Vol 53 (1) ◽  
pp. 39-47 ◽  
Author(s):  
Wilbert B. van den Hout ◽  
Zuzana de Jong ◽  
Marten Munneke ◽  
Johanna M. W. Hazes ◽  
Ferdinand C. Breedveld ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cost Effectiveness ◽  
Physical Therapy ◽  
High Intensity ◽  
Exercise Program ◽  
Cost Utility ◽  
High Intensity Exercise

scholarly journals Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis?: Results of a randomized controlled trial

2003 ◽  
Vol 48 (9) ◽  
pp. 2415-2424 ◽  
Author(s):  
Zuzana de Jong ◽  
Marten Munneke ◽  
Aeilko H. Zwinderman ◽  
Herman M. Kroon ◽  
Annemarie Jansen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Randomized Controlled Trial ◽  
High Intensity ◽  
Controlled Trial ◽  
Exercise Program ◽  
High Intensity Exercise ◽  
Randomized Controlled

scholarly journals Long-term follow-up of a high-intensity exercise program in patients with rheumatoid arthritis

2009 ◽  
Vol 28 (6) ◽  
pp. 663-671 ◽  
Author(s):  
Zuzana de Jong ◽  
Marten Munneke ◽  
Herman M. Kroon ◽  
Dirkjan van Schaardenburg ◽  
Ben A. C. Dijkmans ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
High Intensity ◽  
Exercise Program ◽  
High Intensity Exercise ◽  
Long Term Follow Up

scholarly journals Slowing of bone loss in patients with rheumatoid arthritis by long-term high-intensity exercise: Results of a randomized, controlled trial

2004 ◽  
Vol 50 (4) ◽  
pp. 1066-1076 ◽  
Author(s):  
Zuzana de Jong ◽  
Marten Munneke ◽  
Willem F. Lems ◽  
Aeilko H. Zwinderman ◽  
Herman M. Kroon ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Randomized Controlled Trial ◽  
Bone Loss ◽  
High Intensity ◽  
Controlled Trial ◽  
High Intensity Exercise ◽  
Randomized Controlled

Heart rate variability mediates motivation and fatigue throughout a high-intensity exercise program

2020 ◽  
Vol 45 (2) ◽  
pp. 193-202
Author(s):  
Derek A. Crawford ◽  
Katie M. Heinrich ◽  
Nicholas B. Drake ◽  
Justin DeBlauw ◽  
Michael J. Carper
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
High Intensity ◽  
Exercise Program ◽  
High Intensity Exercise ◽  
Mediating Effect ◽  
Exercise Session ◽  
Physical Fatigue ◽  
Exercise Programs

High-intensity exercise interventions are often promoted as a time-efficient public health intervention to combat chronic disease. However, increased physical effort and subsequent fatigue can be barriers to long-term maintenance of high-intensity exercise programs. The purpose of the present study was to determine if heart rate variability (HRV) mediated state traits related to exercise program adherence. Fifty-five healthy men and women (ages 19–35 years) used a commercially available smartphone application to monitor daily HRV status throughout a 6-week high-intensity exercise intervention. Participants reported state motivation to exercise and global physical fatigue immediately prior to each exercise session. Temporary shifts toward increased parasympathetic reactivation (p = 0.030) resulted in significant increases in daily fatigue (p < 0.001) and decreases in motivation to exercise (p = 0.028). Through modulation of exercise volume, in response to these temporary shifts in HRV, these effects were reversed (p < 0.001) via increased parasympathetic withdrawal (p = 0.018). For the first time, these data demonstrate a mediating effect of HRV on adherence-related trait states throughout a high-intensity exercise program. Applied strategies, such as appropriately timed exercise volume moderation, may be able to leverage this effect and help facilitate long-term exercise program maintenance. Novelty These data establish a link between expected shifts in HRV throughout high-intensity exercise programs with motivation to participate and physical fatigue. Modulation of training volume, in response to these shifts, can optimize adherence-related behavioral responses during high-exercise programs.

scholarly journals Cost-Effectiveness and Cost-Utility of Long-Term Management Strategies for Heartburn

2002 ◽  
Vol 5 (4) ◽  
pp. 312-328 ◽  
Author(s):  
Ron Goeree ◽  
Bernie J. O'Brien ◽  
Gordon Blackhouse ◽  
John Marshall ◽  
Andrew Briggs ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Management Strategies ◽  
Cost Utility ◽  
Term Management

scholarly journals Cost-effectiveness analysis of treatment sequences containing tofacitinib for the treatment of rheumatoid arthritis in Spain

2020 ◽  
Vol 39 (10) ◽  
pp. 2919-2930 ◽  
Author(s):  
F. Navarro ◽  
J. M. Martinez-Sesmero ◽  
A. Balsa ◽  
C. Peral ◽  
M. Montoro ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Inadequate Response ◽  
Concomitant Treatment ◽  
Biological Therapies ◽  
Biological Drugs ◽  
Line Therapy ◽  
Treatment Sequences

Abstract Objective To assess the cost-effectiveness of tofacitinib-containing treatment sequences versus sequences containing only standard biological therapies in patients with moderate-to-severe rheumatoid arthritis (RA) after the failure of conventional synthetic disease-modifying antirheumatic drugs (csDMARD-IR population) and in patients previously treated with methotrexate (MTX) who show an inadequate response to second-line therapy with any tumour necrosis factor inhibitor (TNFi-IR population). Methods A patient-level microsimulation model estimated, from the perspective of the Spanish Public NHS, lifetime costs and quality-adjusted life years (QALY) for treatment sequences starting with tofacitinib (5 mg twice daily) followed by biological therapies versus sequences of biological treatments only. Concomitant treatment with MTX was considered. Model’s parameters comprised demographic and clinical inputs (initial Health Assessment Questionnaire [HAQ] score and clinical response to short- and long-term treatment). Efficacy was measured by means of HAQ score changes using mixed treatment comparisons and data from long-term extension (LTE) trials. Serious adverse events (SAEs) data were derived from the literature. Total cost estimation (€, 2018) included drug acquisition, parenteral administration, disease progression and SAE management. Results In the csDMARD-IR population, sequences starting with tofacitinib proved dominant options (more QALYs and lower costs) versus the corresponding sequences without tofacitinib. In the TNFi-IR population, first-line treatment with tofacitinib+MTX followed by scAbatacept+MTX➔rituximab+MTX➔certolizumab+MTX proved dominant versus scTocilizumab+MTX➔scAbatacept+MTX➔rituximab+MTX➔certolizumab+MTX; and tofacitinib+MTX➔scTocilizumab+MTX➔scAbatacept+MTX➔rituximab+MTX versus scTocilizumab+MTX➔scAbatacept+MTX➔rituximab+MTX➔certolizumab+MTX was less effective but remained a cost-saving option. Conclusions Inclusion of tofacitinib seems a dominant strategy in moderate-to-severe RA patients after csDMARDs failure. Tofacitinib, as initial third-line therapy, proved a cost-saving strategy (€− 337,489/QALY foregone) in moderate-to-severe TNFi-IR RA patients. Key points• Therapeutical approach in rheumatoid arthritis (RA) consisted in sequences of several therapies during patient lifetime.• Treatment sequences initiating with tofacitinib followed by biological drugs provided higher health effects in csDMARDs-IR population, compared with sequences containing only biological drugs.• In both csDMARD-IR and TNFi-IR RA populations, initiating treatment with tofacitinib was associated to lower treatment costs for the Spanish National Health System.

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