Cost-effectiveness evaluation of sunitinib as first-line targeted therapy for metastatic renal cell carcinoma in Spain.

INTRODUCTION Sunitinib, an oral, multitargeted receptor tyrosine kinase inhibitor, delays disease progression, with a median overall survival (OS) of more than 2 years, improves quality of life and is becoming the first-line standard of care for metastatic renal carcinoma (mRCC). PURPOSE To assess the economic value of sunitinib as fi rst-line therapy in mRCC within the Spanish healthcare system. METHODS An adapted Markov model with a 10-year time horizon was used to analyse the cost effectiveness of sunitinib vs. sorafenib (SFN) and bevacizumab/interferon-α (BEV/IFN) as first-line mRCC therapy from the Spanish third-party payer perspective. Progression-free survival (PFS) and OS data from sunitinib, SFN and BEV/IFN pivotal trials were extrapolated to project survival and costs in 6-week cycles. Results, in progression-free life-years (PFLY), life years (LY) and quality-adjusted life-years (QALY) gained, expressed as incremental cost-effectiveness ratios (ICER) with costs and benefits discounted annually at 3%, were obtained using deterministic and probabilistic analyses. RESULTS Sunitinib was more effective and less costly than both SFN (gains of 0.52 PFLY, 0.16 LY, 0.17 QALY) and BEV/IFN (gains of 0.19 PFLY, 0.23 LY, 0.16 QALY) with average cost savings/patients of €1,124 and €23,218, respectively. Using a willingness-to-pay (WTP) threshold of €50,000/QALY, sunitinib achieved an incremental net benefit (INB) of €9,717 and €31,211 compared with SFN and BEV/IFN, respectively. At this WTP, the probability of sunitinib providing the highest INB was 75%. CONCLUSION Our analysis suggests that sunitinib is a costeffective alternative to other targeted therapies as first-line mRCC therapy in the Spanish healthcare setting.

[Heart rate, blood lactate concentration and subjective stress perception in submaximal running: new nomograms for assessment of endurance capacity]. / Herzfrequenz, Blutlaktatkonzentration und subjektives Belastungsempfinden bei submaximaler Laufbelastung: neue Nomogramme zur Abschätzung des Dauerleistungsvermögens.

Considering the protective effect of physical activity against coronary heart disease, the estimation of endurance capacity is not only recommended for sportsmen but is also useful for exercise counselling of unfit persons. Endurance capacity can be estimated with test protocols leading to complete exhaustion, or by submaximal test procedures. Submaximal tests have the advantage of putting less stress on subjects than maximal test protocols; on the other hand, they are less accurate. As a complement to traditional submaximal test protocols based on heart rate analysis, a new submaximal protocol is proposed based on measurements of capillary blood lactate concentration during exercise. Incremental tests of 319 men with wide variation of endurance capacity were used to calculate nomograms of the typical pattern of exercise-induced increase in capillary blood lactate concentration, heart rate, and rating of perceived exertion in relation to endurance capacity. The running velocity eliciting a capillary blood concentration of 4 mmol/l lactate was selected as the parameter for endurance capacity. With the help of these nomograms, the 4 mmol/l-velocity could be estimated with submaximal values of lactate, heart rate or rating of perceived exertion. The appropriateness of the nomograms was checked against the data of 100 independent maximal treadmill tests. Estimation of 4 mmol/l-velocity with submaximal lactate values showed good precision (with a small standard deviation of +/-0.17 m/s); in contrast, the estimation of endurance capacity with submaximal values for heart rate and rating of perceived exertion showed substantially larger standard deviations (approximately +/-0.56 m/s). We conclude that, for estimation of endurance capacity from submaximal running values, the nomogram for blood lactate concentrations can be recommended.

Development of public policy and physical activity initiatives internationally.

Epidemiological, pathological, clinical, and experimental studies over the past 40 years convincingly show that physical inactivity and low physical fitness contribute substantially to the major chronic diseases prevalent in industrialised societies. Several industrialised countries around the world report increases in physical activity participation among adults in recent years, but the prevalence of inactivity remains high. These increases in voluntary exercise are at least partially offset by decreasing daily energy demands due to increased mechanisation at home, at work and during leisure-time. In developing countries, physical inactivity is becoming a prevalent lifestyle due to rapid social and economic changes. Clinical interventions and mass appeals to be more physically active are limited in effectiveness against the background of increasingly sedentary lifestyles. Exercise scientists and public health officials need to turn attention to public policy and legislative initiatives to restructure physical and social environments to encourage more physical activity and discourage sedentary habits.

On the epidemiology of sports injuries in Switzerland.

A review of the current literature and of insurance data sources on sports injuries in Switzerland during the latest decade is presented. Epidemiological denominator data to determine the population-at-risk and the exposure time are scarce and it is therefore recommended that both the quantity and the quality of Swiss research in this field will be enhanced. It is also proposed that at least one academic institution in Switzerland would assemble systematically all available data of standard format on sports and recreational injuries to ensure a continuous analysis of these data.

[Physiological, social and motivational characteristics of fitness center clients]. / Physiologische, soziale und motivationale Charakteristika von Fitnesscenterbesuchern.

Physiological, social and motivational characteristics of attendants to a fitness club. Little is known on the epidemiology of exercisers not engaging into competitive sports events, such as those attending fitness clubs. We investigated 85 regular attendants to a fitness club in Zurich, Switzerland: 44 men and 41 women, with a mean age of 35 (+/- 10) years. All subjects carried out the club-based fitness-test and answered additional questions on sports activity, lifestyle, and their motives to exercise. As anticipated, fitness club attendants smoked less and were more active and more educated than the general population. Among fitness club attendants themselves, known and plausible interrelationships between endurance capacity, body fat content, and habitual exercise could be confirmed as highly significant. Body fat content, as estimated from bioimpedance measurement, was more closely related to important dependent variables than the body mass index, for example to female endurance capacity (r = -0.33 vs. -0.03), or to age in men (r = 0.48 vs. 0.22). Unexpectedly, social factors were only poor predictors of differences in fitness and exercise levels within the study sample. Compared with joggers, fitness club attendants seemed to be motivated relatively more by targets of health promotion, e.g. weight control, and less motivated by "intrinsic" joy and fun with sports activity itself. Further studies will have to demonstrate whether fitness clubs are actually able to promote "lifetime exercise".

10-year trends in physical activity in the eastern Finnish adult population: relationship to socioeconomic and lifestyle characteristics.

In a large, community-based cardiovascular disease prevention study in Eastern Finland, independent random population samples were surveyed in 1972, 1977 and 1982. The leisure-time physical activity (LTPA), occupational physical activity (OPA), and socioeconomic and lifestyle characteristics were assessed. In men and women aged 30-59, the proportion with high LTPA increased from 1972 to 1982 by approximately one half (p less than 0.001), whereas that of high OPA decreased during the same period (p less than 0.001). In both sexes, high overall physical activity fell from 1972 to 1977 (p less than 0.001), but no more from 1977 to 1982. The proportion of entirely sedentary remained stable. Education, income and younger age showed a positive, body mass index, smoking and OPA a graded, negative association with high LTPA in 1972 and 1982. Significant (p less than 0.001) differences in 10-year trends of changes in LTPA were observed: men and women with low education or income increased LTPA more than those with high education and income. Socioeconomic factors, such as income and education, appear to have lost importance as determinants of population-wide exercise, whereas the clustering of low physical activity with overweight and smoking has increased.