ABSTRACT
Introducción y objetivos A pesar de los avances en el tratamiento, la enfermedad cardiovascular es la segunda causa de muerte en España. El objetivo de este estudio fue determinar el coste-efectividad de la estrategia polipíldora CNIC (ácido acetilsalicílico 100mg, atorvastatina 20/40mg, ramipril 2,5/5/10mg) comparada con los mismos monocomponentes por separado para la prevención secundaria de eventos cardiovasculares recurrentes en adultos en España. Materiales y métodos Se adaptó un modelo Markov considerando 4 estados de salud (estable, evento cardiovascular adverso mayor posterior, ictus isquémico posterior y muerte) y la ecuación de riesgo SMART con un horizonte temporal de toda la vida desde la perspectiva del Sistema Nacional de Salud español. La estrategia polipíldora CNIC se comparó con monocomponentes en una cohorte hipotética de 1.000 pacientes en prevención secundaria.Los datos de efectividad, epidemiológicos, de costes y de utilidades se obtuvieron del estudio NEPTUNO, de bases de datos oficiales y de la literatura. Los resultados fueron los costes (en euros de 2021) por año de vida (AV) ganados y por años de vida ajustados por calidad (AVAC) ganados. Se aplicó una tasa de descuento del 3%. Se realizaron análisis de sensibilidad determinísticos univariantes y probabilísticos para evaluar la solidez del modelo. Resultados La estrategia polipíldora CNIC, en prevención secundaria, produce más ganancias de AV (13,22) y AVAC (11,64) a un coste inferior que los monocomponentes. La polipíldora CNIC es dominante y ahorra 280,68euros por paciente en comparación con los monocomponentes por separado. El análisis de sensibilidad probabilístico muestra que el 82,4% de las simulaciones están por debajo del umbral de 25.000euros por AVAC ganado (AU)
Introduction and objectives Despite advances in treatment, cardiovascular disease is the second leading cause of death in Spain. The objective of this study was to determine the cost-effectiveness of the CNIC-Polypill strategy (acetylsalicylic acid 100mg, atorvastatin 20/40mg, ramipril 2.5/5/10mg) compared with the same separate monocomponents for the secondary prevention of recurrent cardiovascular events in adults in Spain. Materials and methods A Markov cost-utility model was adapted considering four health states (stable, subsequent major adverse cardiovascular event, subsequent ischemic stroke and death) and the SMART risk equation over a lifetime horizon from the perspective of the Spanish National Healthcare System. The CNIC-Polypill strategy was compared with monocomponents in a hypothetical cohort of 1000 secondary prevention patients. Effectiveness, epidemiological, cost and utilities data were obtained from the NEPTUNO study, official databases and literature. Outcomes were costs (in 2021euros) per life-year (LY) and quality-adjusted LY (QALY) gained. A 3% discount rate was applied. Deterministic one-way and probabilistic sensitivity analyses evaluated the robustness of the model. Results The CNIC-Polypill strategy in secondary prevention results in more LY (13.22) and QALY (11.64) gains at a lower cost than monocomponents. The CNIC-Polypill is dominant and saves 280.68 per patient compared with monocomponents. The probabilistic sensitivity analysis shows that 82.4% of the simulations are below the threshold of 25,000 per QALY gained. Conclusions The CNIC-Polypill strategy in secondary cardiovascular prevention is cost-effective compared with the same separate monocomponents, resulting in a cost-saving strategy to the Spanish National Healthcare System (AU)
Subject(s)
Humans , Cardiovascular Diseases/prevention & control , Cost-Benefit Analysis , Aspirin/administration & dosage , Atorvastatin/administration & dosage , Ramipril/administration & dosage , Markov Chains , SpainABSTRACT
Objetivo. El cáncer de mama (CM) es el más común entre las mujeres occidentales, con un alto porcentaje de supervivencia, la cual no está exenta de numerosos efectos secundarios tanto por los tratamientos como por la enfermedad, afectando a la calidad de vida de estas mujeres. El objetivo de este proyecto es conocer el efecto de un programa de ejercicio físico conducido en la calidad de vida de mujeres afectadas por cáncer de mama. Método. El programa de ejercicio físico consistió en 24 sesiones (doce semanas) y se desarrolló íntegramente en la Facultad de Ciencias de la Actividad Física y del Deporte-INEF (UPM), donde se estudió a 31 mujeres afectadas. Resultados. Se muestra una mejora en la calidad de vida (p= 0,034), así como en diferentes aspectos de autoestima y depresión (p = 0,029 y p = 0,003 para el primero y p = 0,018 y p = 0,015 para el segundo). También se observó una mejora en el índice de fuerza general (p = 0,009) y en la capacidad funcional (p = 0,005). Conclusiones. Estos resultados permiten asociar un programa de ejercicio físico regular con posibles mejoras en la calidad de vida de las mujeres afectadas por cáncer de mama(AU)
Objective. Breast cancer is the most common cancer in occidental women. It presents a very high survival with a lot of side effect produced by the treatments, what affect to these women quality of life. Our goal is to know the effect of a guide exercise program on quality of life of breast cancer women. Methods. This program consisted in 24 classes and it was developed in the faculty of Physical Activity and Sport Science (UPM). 31 women were studied. Results. They showed an increase in their quality of life (p = 0.034), and in different psychological aspects as depression (p = 0.029 y p = 0.003) and self-esteem (p = 0.018 y p = 0.015). Also a positive change was observed in the global strength (p = 0.009) and in the functional capacity (p = 0.005). Conclusion. These results suggest that could exist an association between regular exercise programs with improvements in quality of life in women with breast cancer(AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Exercise/physiology , Physical Exertion/physiology , Breast Neoplasms/epidemiology , Breast Neoplasms/prevention & control , Quality of Life , Motor Activity/immunology , Motor Activity/physiology , Sports/physiology , Breast Neoplasms/physiopathology , Breast Neoplasms/rehabilitation , Pilot Projects , Sports/education , Psychomotor Performance/physiologyABSTRACT
We show how asymmetries in the movement patterns during the process of regaining balance after perturbation from quiet stance can be modeled by a set of coupled vector fields for the derivative with respect to time of the angles between the resultant ground reaction forces and the vertical in the anteroposterior and mediolateral directions. In our model, which is an adaption of the model of Stirling and Zakynthinaki (2004), the critical curve, defining the set of maximum angles one can lean to and still correct to regain balance, can be rotated and skewed so as to model the effects of a repetitive training of a rotational movement pattern. For the purposes of our study a rotation and a skew matrix is applied to the critical curve of the model. We present here a linear stability analysis of the modified model, as well as a fit of the model to experimental data of two characteristic "asymmetric" elite athletes and to a "symmetric" elite athlete for comparison. The new adapted model has many uses not just in sport but also in rehabilitation, as many work place injuries are caused by excessive repetition of unaligned and rotational movement patterns.
Subject(s)
Movement , Nonlinear Dynamics , Postural Balance , Rotation , Algorithms , Athletes , Humans , Linear Models , Martial Arts , Models, Anatomic , Models, StatisticalABSTRACT
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