Objective: Patients with relapsing-remitting multiple sclerosis (RRMS) treated with disease modifying therapies (DMTs) who continue to experience disease activity may be considered for escalation therapies such as fingolimod, or may be considered for alemtuzumab. Previous economic modeling used Markov models; applying one alternative technique, discrete event simulation (DES) modeling, allows re-treatment and long-term adverse events (AEs) to be included in the analysis.
Methods: A DES was adapted to model relapse-triggered re-treatment with alemtuzumab and the effect of including ongoing quality-adjusted life year (QALY) decrements for AEs that extend beyond previous 1-year Markov cycles. As the price to the NHS of fingolimod in the UK is unknown, due to a confidential patient access scheme (PAS), a variety of possible discounts were tested. The interaction of re-treatment assumptions for alemtuzumab with the possible discounts for fingolimod was tested to determine which DMT resulted in lower lifetime costs. The lifetime QALY results were derived from modeled treatment effect and short- and long-term AEs.
Results: Most permutations of fingolimod PAS discount and alemtuzumab re-treatment rate resulted in fingolimod being less costly than alemtuzumab. As the percentage of patients who are re-treated with alemtuzumab due to experiencing a relapse approaches 100% of those who relapse whilst on treatment, the discount required for fingolimod to be less costly drops below 5%. Consideration of treatment effect alone found alemtuzumab generated 0.2 more QALYs/patient; the inclusion of AEs up to a duration of 1 year reduced this advantage to only 0.14 QALYs/patient. Modeling AEs with a lifetime QALY decrement found that both DMTs generated very similar QALYs with the difference only 0.04 QALYs/patient.
Conclusions: When the model captured alemtuzumab re-treatment and long-term AE decrements, it was found that fingolimod is cost-effective compared to alemtuzumab, assuming application of only a modest level of confidential PAS discount. 相似文献
The purpose of this study was explore the body image experiences of women who play tackle football. Data included semi-structured interviews with 15 players on a women's tackle football team in Western Canada. Data were analyzed thematically and objectification theory was used to interpret the findings. Themes that emerged included: a) improved body image through physical change, appreciation of function over appearance and shifting ideals of beauty; b) importance of a social atmosphere that celebrated diverse bodies; and c) negotiation of body image on and off the field. Research has documented a connection between body image and physically active leisure, but much about the nature of the relationship is still unclear. The findings of this study provide insight into elements of physically active leisure (e.g., social atmosphere or nature of the activity) which can be used to promote positive body image, health, and wellness in leisure settings. 相似文献
A phenomenological framework guided data collection and analysis of the prevalent influences on attitudes and behaviors of elementary, junior, and secondary school students towards their physically active leisure. Twenty-two students participated in individual in-depth interviews. Parental influence and outdoor play effected choice and level of physically active leisure for elementary students. Opportunities for organized and non-structured physically active leisure and friends were significant for junior students. Academic responsibilities and organized physically active leisure were influential for secondary students. Common threads were parental influence and the belief that the students were too old to start new activities. These findings highlight the importance of providing opportunities in safe environments for children and youth to participate in a variety of structured and non-structured forms of physically active leisure. 相似文献
This study examines the on-site co-creation experience from a tourist perspective. A review of the literature and in-depth interviews with tourists who participated in a ‘swimming with dolphins’ experience are used to explore the importance of co-creation in enhancing attention and the memorability of the experience. Findings suggest that the co-creation experience influences memorability by focusing the tourist’s attention. This study contributes to the conceptualization of co-creation in the field of tourism by substantiating the usefulness of a psychologically based approach to experience design. 相似文献