BACKGROUND: Dyslipidaemia is a key risk factor for atherosclerotic cardiovascular disease (ASCVD), necessitating effective statin therapy. Despite statins' proven safety and efficacy, adherence remains suboptimal, with significant gaps between clinical practice and guideline recommendations. METHODS: This retrospective cohort study analysed anonymized health administrative claims data from six employee health funds in the Czech Republic, covering approximately 40% of the insured population from January 1, 2017, to December 31, 2020. We identified statin-incident as well as prevalent cohort of patients. Adherence to statin therapy was assessed using the proportion of days covered (PDC) metric, with factors such as age, gender, sequence of use, and treatment intensity considered as modifiers. RESULTS: Among the statin-prevalent cohort (SP, n = 890,180), 83.5% achieved a PDC ≥ 50%, and 61.0% reached a PDC ≥ 80%. In the statin-incident cohort (SI, n = 287,871), a clear trend of increasing adherence with age and medication sequence was observed: in adults aged 18-39 median PDC rose from 84.1% (IQR: 57-100) in the first to 94.7% (IQR: 75.6-100) in the third sequence; in those aged 80 + median PDC rose from 95.0% (IQR: 68.9-100) in the first to 100% (IQR: 78.3-100) in the third sequence. Logistic regression identified age (OR=1.011 per year), female gender (OR=0.896), high-intensity treatment (OR=0.975), and second (OR=1.267) or later treatment sequences (OR=1.704) as significant predictors of adherence (all p < 0.001). CONCLUSION: Adherence to statin therapy improves with subsequent treatment sequences and age. These findings highlight the need for targeted interventions to enhance adherence, particularly among younger patients. The PDC metric is recommended for integration into clinical practice to monitor and improve medication adherence.

• MeSH
• adherence k farmakoterapii * MeSH
• dospělí MeSH
• dyslipidemie * farmakoterapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• retrospektivní studie MeSH
• senioři MeSH
• statiny * terapeutické užití   MeSH
• věkové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Názvy látek
• statiny * MeSH

BACKGROUND: Myasthenia gravis (MG) is a rare autoimmune disorder with significant clinical implications, including life-threatening myasthenic crises and exacerbations. Understanding real-world treatment patterns, especially associated direct medical costs, is essential for the effective management of healthcare delivery. METHODS: We conducted a descriptive cohort study using health administrative claims data from the Czech Republic covering more than 1,500 prevalent MG patients. Data were analysed for healthcare resource utilization, medication costs, and hospitalization rates related to MG and its complications. RESULTS: Acetylcholine inhibitors and corticosteroids were widely prescribed, with 91.1% and 75.2% of patients receiving them at least once, respectively. Immunosuppressive therapy was given to 45.2% of patients. Myasthenic crises occurred in 2% of patients, with a mean hospitalization cost of 21,020 EUR, while exacerbations occurred in 9.2% of patients, with lower costs (5,951 EUR per hospitalization). Outpatient intravenous immunoglobulin and plasma exchange therapies incurred additional costs of 20,700 EUR and 18,206 EUR per person-year, respectively. The mean total cost per patient-year was 1,271 EUR, with significant cost differences among patients with different treatment patterns. CONCLUSION: This study offers real-world insights into the treatment patterns and associated direct medical costs of MG in the Czech Republic. Myasthenic crises and exacerbations pose considerable cost burdens, while outpatient therapies and common pharmacotherapies are less costly. These findings are vital for healthcare planning, economic evaluation, and resource allocation, potentially leading to enhanced patient care and outcomes.

• Klíčová slova
• Direct healthcare costs, Myasthenia gravis, Treatment patterns,
• MeSH
• dospělí MeSH
• hospitalizace ekonomika   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• myasthenia gravis * ekonomika   terapie   farmakoterapie   MeSH
• náklady na zdravotní péči MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

Background and Objectives: There is little information on changes in the process and outcomes of intensive tobacco dependence treatment during the COVID-19 pandemic. The following characteristics were evaluated: interest in treatment, the number of face-to-face or telephone follow-ups, the duration of pharmacotherapy use, and the success rate. The aim of our study was to compare the number of patients who entered tobacco dependence treatment programmes and evaluate the one-year success rate in patients three years before and three years after the COVID-19 pandemic. Materials and Methods: A single-site retrospective cohort study using data from patients treated at the Centre for Tobacco Dependence in Prague, Czech Republic, between 2017 and 2022 (n = 2039) was performed. The one-year abstinence rate was validated by measuring carbon monoxide in exhaled air (6 ppm cut-off). Patients were divided into two groups: the group for which treatment was initiated in 2017-2019 (i.e., before the COVID-19 pandemic, BC; n= 1221) and the group for which treatment was initiated in 2020-2022 (i.e., during the COVID-19 pandemic, DC; n = 818). Results: No significant differences in the success rate of tobacco dependence treatment were found between the two groups (BC group, 40.5% (494/1221) vs. DC group, 42.2% (345/818)) (χ2 (1, N = 2.039) = 0.6, p = 0.440). Furthermore, differences were not found in sex, education level, age at first cigarette, the duration of pharmacotherapy use, or the number of in-person visits. In contrast, there was an increase in the number of telephone contacts between the groups (18.7% (SD = 17.5%) vs. 32.9% (SD = 18.2%), p < 0.001). Conclusions: The number of patients who started treatment during the COVID-19 pandemic decreased by one-third compared to that during the 3-year period before the pandemic. The overall treatment success rate did not change significantly even with the increase in the number of telephone visits with the therapist.

• Klíčová slova
• COVID-19 pandemic, tobacco dependence, treatment,
• MeSH
• COVID-19 * epidemiologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• odvykání kouření metody   statistika a číselné údaje   MeSH
• pandemie MeSH
• poruchy vyvolané užíváním tabáku * terapie   epidemiologie   MeSH
• retrospektivní studie MeSH
• SARS-CoV-2 MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

OBJECTIVE: Lower limb peripheral arterial disease in the symptomatic stage has a significant effect on patients´ functional disability. Before an intervention, an imaging diagnostic examination is necessary to determine the extent of the disability. This study evaluates cost-effectiveness of duplex ultrasonography (DUS), digital subtraction angiography (DSA), computed tomography angiography (CTA) and magnetic resonance angiography (MRA) in the diagnostics of symptomatic patients with lower limb peripheral arterial disease indicated for endovascular or surgical intervention. METHODS: Discrete event simulation was used to capture lifetime costs and effects. Costs were calculated from the perspective of the health care payer, and the effects were calculated as quality-adjusted life year's (QALY's). The cost-effectiveness analysis was performed to pairwise compare CTA, MRA and DSA with DUS as the baseline diagnostic modality. A scenario analysis and probabilistic sensitivity analysis were carried out to evaluate the robustness of the results. RESULTS: In the basic case, the DUS diagnostic was the least expensive modality, at a cost of EUR 10,778, compared with EUR 10,804 for CTA, EUR 11,184 for MRA, and EUR 11,460 for DSA. The effects of DUS were estimated at 5.542 QALYs compared with 5.554 QALYs for both CTA and MRA, and 5.562 QALYs for DSA. The final incremental cost-effectiveness ratio (ICER) value of all evaluated modalities was below the cost-effectiveness threshold whereas CTA has the lowest ICER of EUR 2,167 per QALY. However, the results were associated with a large degree of uncertainty, because iterations were spread across all cost-effectiveness quadrants in the probabilistic sensitivity analysis. CONCLUSION: For imaging diagnosis of symptomatic patients with lower limb peripheral arterial disease, CTA examination appears to be the most cost-effective strategy with the best ICER value. Baseline diagnostics of the DUS modality has the lowest costs, but also the lowest effects. DSA achieves the highest QALYs, but it is associated with the highest costs.

• Klíčová slova
• cost-effectiveness, diagnostic modalities, discrete event simulation, lifetime costs and effects, symptomatic lower limb peripheral disease,
• MeSH
• analýza nákladů a výnosů * MeSH
• CT angiografie ekonomika   statistika a číselné údaje   MeSH
• diagnostické zobrazování ekonomika   statistika a číselné údaje   MeSH
• digitální subtrakční angiografie * ekonomika   MeSH
• dolní končetina * diagnostické zobrazování   MeSH
• duplexní dopplerovská ultrasonografie ekonomika   MeSH
• kvalitativně upravené roky života * MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční angiografie ekonomika   MeSH
• onemocnění periferních arterií * diagnostické zobrazování   ekonomika   MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: In recent years, there has been an increasing effort to take advantage of the potential use of low magnetic induction devices with less than 1 T, referred to as Low-Field MRI (LF MRI). LF MRI systems were used, especially in the early days of magnetic resonance technology. Over time, magnetic induction values of 1.5 and 3 T have become the standard for clinical devices, mainly because LF MRI systems were suffering from significantly lower quality of the images, e.g., signal-noise ratio. In recent years, due to advances in image processing with artificial intelligence, there has been an increasing effort to take advantage of the potential use of LF MRI with induction of less than 1 T. This overview article focuses on the analysis of the evidence concerning the diagnostic efficacy of modern LF MRI systems and the clinical comparison of LF MRI with 1.5 T systems in imaging the nervous system, musculoskeletal system, and organs of the chest, abdomen, and pelvis. METHODOLOGY: A systematic literature review of MEDLINE, PubMed, Scopus, Web of Science, and CENTRAL databases for the period 2018-2023 was performed according to the recommended PRISMA protocol. Data were analysed to identify studies comparing the accuracy, reliability and diagnostic performance of LF MRI technology compared to available 1.5 T MRI. RESULTS: A total of 1275 publications were retrieved from the selected databases. Only two articles meeting all predefined inclusion criteria were selected for detailed assessment. CONCLUSIONS: A limited number of robust studies on the accuracy and diagnostic performance of LF MRI compared with 1.5 T MRI was available. The current evidence is not sufficient to draw any definitive insights. More scientific research is needed to make informed conclusions regarding the effectiveness of LF MRI technology.

• Klíčová slova
• diagnostic accuracy, diagnostic efficacy, low field magnetic resonance, magnetic resonance,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

This paper focuses on research in expert elicitation as a part of the early stage health technology assessment (eHTA). The current state of affairs is analysed and two elicitation approaches are compared-the four fixed intervals method and the histogram method-as applied to an example of early assessment of clinical effectiveness of artificial thymus for patients with DiGeorge syndrome. A survey was carried out consisting of four questions concerning the topic, with the aim to apply the elicitation methods. Eight experts answered the questions using both elicitation methods. Based on their answers, the methods were compared visually and by means of statistical tests. In order to compare the perception of the two elicitation methods, the survey also included questions regarding the experts' subjective preferences. The results of the comparison of the two elicitation approaches did not clearly confirm which method was more beneficial and better; however, it was possible to indicate which of the two methods is better suited for different types of experts. Before selecting an elicitation method as a part of eHTA, it is advisable to effectively consider the technology to be assessed and the type of experts to be invited to share their opinion.

• Klíčová slova
• artificial thymus, eHTA, early health technology assessment, elicitation, expert opinion,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: There has been a noticeable relative increase in psychiatric comorbidities among smokers as opposed to the general population. This is likely due to comparatively slower decrease in smoking prevalence among individuals with mental health conditions. This study aims to assess the prevalence trend of past or current mental health disorders in individuals seeking specialized smoking cessation assistance. METHODS: We conducted a retrospective single-centre observational study to assess the presence of mental disorders such as anxiety, depression, bipolar affective disorder, or schizophrenia in personal history of 6,546 smokers who sought treatment at the Centre for Treatment of Tobacco Dependence in Prague, Czech Republic between 2006 and 2019. The study examined the impact of gender, age, and the effect of successive years on the prevalence of the mental disorders using Poisson distribution regression. RESULTS: In the studied cohort, 1,743 patients (26.6%) reported having one or more mental disorders. Compared to patients without a psychiatric disorder, they exhibited similar levels of carbon monoxide in expired air (mean 17 ppm, SD 11 ppm) and scored one point higher on the Fagerström Test of Cigarette Dependence. Among smokers with a mental disorder, women were more prevalent (62%) than men (38%). The prevalence of mental disorders increased on average by 4% every year, rising from 23% in 2006 to 35% in 2019. CONCLUSIONS: Consistent with the observation that the prevalence of smoking among people with any mental disorder is higher and declining at a slower rate than in the general population, there is a steadily increasing percentage of these patients seeking specialized treatment over time. Professionals who offer tobacco dependence treatment should be aware of the upward trend in psychiatric disorders among smokers, as more intensive treatment may be needed. Similarly, psychiatric care should pay attention to smoking of their patients.

• Klíčová slova
• Comorbidity, Prevalence, Psychiatric disorders, Smoking cessation, Tobacco dependence, Treatment,
• MeSH
• duševní poruchy * epidemiologie   MeSH
• kuřáci MeSH
• lidé MeSH
• poruchy vyvolané užíváním tabáku * epidemiologie   terapie   MeSH
• prevalence MeSH
• retrospektivní studie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH

Lower limb ischemic disease (LEAD) affects a significant portion of the population, with most patients being asymptomatic. Patient screening is necessary because LEAD patients have an increased risk of occurrence of other cardiovascular events and manifestations of disease, in terms of leg symptoms such as intermittent claudication, critical limb ischemia, or amputation. The aim of this work was to evaluate the cost-effectiveness of screening using ABI diagnostics in asymptomatic patients and its impact on limb symptoms associated with LEAD. A discrete event simulation model was created to capture lifetime costs and effects. Costs were calculated from the perspective of the health care payer, and the effects were calculated as QALYs. A cost-effectiveness analysis was performed to compare ABI screening examination and the situation without such screening. A probabilistic sensitivity analysis and scenario analysis were carried out to evaluate the robustness of the results. In the basic setting, the screening intervention was a more expensive intervention, at a cost of CZK 174,010, compared to CZK 70,177 for the strategy without screening. The benefits of screening were estimated at 14.73 QALYs, with 14.46 QALYs without screening. The final ICER value of CZK 389,738 per QALY is below the willingness to pay threshold. Likewise, the results of the probabilistic sensitivity analysis and of the scenario analysis were below the threshold of willingness to pay, thus confirming the robustness of the results. In conclusion, ABI screening appears to be a cost-effective strategy for asymptomatic patients aged 50 years when compared to the no-screening option.

• Klíčová slova
• ankle-brachial index, cost-effectiveness analysis, discrete event simulation, lower extremity arterial disease, screening,
• MeSH
• amputace MeSH
• analýza nákladů a výnosů MeSH
• dolní končetina MeSH
• kvalitativně upravené roky života MeSH
• lidé MeSH
• nemoci cév * MeSH
• plošný screening * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Obstructive sleep apnea (OSA) is a risk factor for several diseases and is correlated with other non-medical consequences that increase the disease's clinical and economic burden. However, OSA's impact is highly underestimated, also due to substantial diagnosis gaps. OBJECTIVE: This study aims at assessing the economic burden of OSA in the adult population in Italy by performing a cost-of-illness analysis with a societal perspective. In particular, we aimed at estimating the magnitude of the burden caused by conditions for which OSA is a proven risk factor. METHODS: A systematic literature review on systematic reviews and meta-analyses, integrated by expert opinion, was performed to identify all clinical and non-clinical conditions significantly influenced by OSA. Using the Population Attributable Fraction methodology, a portion of their prevalence and costs was attributed to OSA. The total economic burden of OSA for the society was estimated by summing the costs of each condition influenced by the disease, the costs due to OSA's diagnosis and treatment and the economic value of quality of life lost due to OSA's undertreatment. RESULTS: Twenty-six clinical (e.g., diabetes) and non-clinical (e.g., car accidents) conditions were found to be significantly influenced by OSA, contributing to an economic burden ranging from €10.7 to €32.0 billion/year in Italy. The cost of impaired quality of life due to OSA undertreatment is between €2.8 and €9.0 billion/year. These costs are substantially higher than those currently borne to diagnose and treat OSA (€234 million/year). CONCLUSIONS: This study demonstrates that the economic burden due to OSA is substantial, also due to low diagnosis and treatment rates. Providing reliable estimates of the economic impact of OSA at a societal level may increase awareness of the disease burden and help to guide evidence-based policies and prioritisation for healthcare, ultimately ensuring appropriate diagnostic and therapeutic pathways for patients.

• MeSH
• dospělí MeSH
• finanční stres MeSH
• kvalita života * MeSH
• lidé MeSH
• náklady na zdravotní péči MeSH
• obstrukční spánková apnoe * epidemiologie   terapie   MeSH
• osobní újma zaviněná nemocí MeSH
• poskytování zdravotní péče MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• systematický přehled MeSH

Young adults are a substantial driver of lagging vaccination against COVID-19 worldwide. We aimed to understand what vaccine or vaccination environment attributes may affect young adults' vaccine inclination. We contacted a convenience sample of 1415 students to recruit a minimum of 150 individuals for a web-based discrete choice experiment. The respondents were asked to choose one of two hypothetical vaccines, defined by six attributes-vaccine efficacy, risk of mild side effects, protection duration, administration route, recommender, and travel time to the vaccination site. Individual preferences were calculated with the Markov chain Monte Carlo hierarchical Bayes estimation. A total of 445 individuals (mean age 24.4 years, 272 (61.1%) women) completed the survey between 22 March and 3 May 2021. Vaccine protection duration (28.3 (95% CI, 27.0-29.6)) and vaccine efficacy in preventing COVID-19 (27.5 (95% CI, 26.3-28.8)) were the most important, followed by the risk of vaccine side effects (17.3 (95% CI, 16.2-18.4)). Individuals reluctant or unsure about vaccination (21.1%) prioritized the potential for mild side effects higher and vaccine efficacy lower than the vaccine-inclined individuals. New vaccination programs that target young adults should emphasize the protection duration, low risk of vaccine side effects, and high efficacy.

• Klíčová slova
• COVID-19, discrete choice experiment, patient preferences, vaccine, vaccine hesitancy, young adults,
• Publikační typ
• časopisecké články MeSH