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.
- 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.
- Publikační typ
- časopisecké články MeSH
- přehledy 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.
- 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
BACKGROUND: When dealing with the replacement of one missing tooth, the patient has the option of choosing between different types of treatment interventions. Several important factors play a role in his decision-making process, including his limited financial means and his efforts to solve the problem of missing teeth as effectively as possible. The main goal of the study is the economic-clinical evaluation of implant treatment, as a surgical-prosthetic method in dentistry, in case of replacement of one missing tooth of the molar area. METHODS: Cost-utility analysis from the patient's perspective is used for evaluation. The selected comparator is a purely prosthetic solution with the help of a three-unit fixed dental prosthesis. Cost-utility analysis is modelled using Markov models, which consider a 30-year time horizon. RESULTS: Based on the results of modelling, the intervention evaluated by the patient, i.e. treatment with the help of implant-supported single crown, brings exactly 15.31 quality-adjusted prosthesis years (QAPY) after 30 years. The value of incremental cost-utility ratio amounted to USD - 1434. CONCLUSION: The results of the cost-utility analysis suggest that implant treatment with an implant-supported single crown is more cost-effective than treatment with the three-unit fixed dental prosthesis.
Amyotrophic lateral sclerosis is a disease with rapid progression. The use of mechanical ventilation helps to manage symptoms and delays death. Use in a home environment could reduce costs and increase quality of life. The aim of this study is a cost-utility analysis of home mechanical ventilation in adult patients with amyotrophic lateral sclerosis from the perspective of healthcare payers in the Czech Republic. The study evaluates home mechanical ventilation (HMV) and mechanical ventilation (MV) in a healthcare facility. A Markov model was compiled for evaluation in a timeframe of 10 years. Model parameters were obtained from the literature and opinions of experts from companies dealing with home care and home mechanical ventilation. The cost-utility analysis was carried out at the end of the study and results are presented in incremental cost-utility ratio (ICUR) using quality-adjusted life-years. Uncertainty was assessed by one-way sensitivity analysis and scenario analysis. The cumulative costs of HMV are CZK 1,877,076 and the cumulative costs of the MV are CZK 7,386,629. The cumulative utilities of HMV are 12.57 quality-adjusted life year (QALY) and the cumulative utilities of MV are 11.32 QALY. The ICUR value is CZK-4,403,259. The results of this study suggest that HMV is cost effective.
- Publikační typ
- časopisecké články MeSH
Background: Cardiovascular diseases have the highest mortality rates and the costs for treatment are very high so far. Cardiovascular rehabilitation helps to reduce the risk of relapses or deterioration of cardiovascular diseases, however, the number of patients that participate is insufficient, especially in later stages of the rehabilitation process. The aim of the study is to evaluate cost-effectiveness of cardiovascular rehabilitation care using cost-utility analysis. Methods: The study evaluate the Cardio ambulance Late Phase, Late Phase of The Spa treatment and for comparison also Early Phase of The Spa treatment in Konstantin Spa. The research was conducted in outpatient facility and spa facility. For QALY, a prospective questionnaire survey was conducted in patients with cardiovascular disease using generic EQ-5D-5L questionnaires. The costs were calculated from the perspective of the health care payer. The cost-utility analysis was carried out at the end of the study and results are presented in incremental cost-utility ratio. Results: The average cost per patient in outpatient facility is CZK 12,459. The average amount for an overall early phase of spa treatment per patient is CZK 35,161. The average amount for an overall late phase spa treatment per patient is CZK 30,503. QALY obtained from Index Value was 0.092 (Konstantin Spa Early Phase), 0.054 (Konstantin Spa Late Phase), 0.26 (Cardio ambulance Late Phase). For Konstantin Spa Late Phase, the ICUR value was 644,436 and for Konstantin Spa Early Phase was 343,981 (comparator is the Cardio ambulance Late Phase). Konstantin Spa Early Phase compared to Konstantin Spa Late Phase had an ICUR value of 122,592. Conclusions: The results of this study suggest that the spa treatment in later stage of the cardiovascular rehabilitation process is cost effective with use of cost effectiveness threshold three times the Gross Domestic Product (GDP) per capita.
- Publikační typ
- časopisecké články MeSH
To use home mechanical ventilation, it is necessary to choose the right target group that can benefit from moving to home care. Moving a patient to home care with home mechanical ventilation involves a number of risks. The aim of this study was to use Health Failure Mode and Effects Analysis (HFMEA) to analyse health risks at a time when a patient is just preparing to move to home care, and a nursing plan is being drawn up. HFMEA was used to analyse health risks. The expert team divided the process of nursing care into 7 parts with other own subprocess, which are 18 in total. Altogether, 41 risks were identified, of which 14 failures were analysed after HFMEA application, potential causes were defined, and their follow-up proposed. According to the results of the method used and the analysis of individual risks, it is necessary to focus on detailed setting of the nursing plan with thorough education of informal caregivers who play an important role in it. The education should be regularly repeated and the check of care itself should be supported by created checklists to confirm the individual steps.
V současné době jsou stále vyvíjeny nové technologie za účelem neustálého zlepšování zdravotní péče. Rozvojem technologií prochází také telemedicína, která se využívá v mnoha oborech. Cílem této studie je porovnat telemonitorační systém s péčí, která je standardně používaným přístupem na gynekologicko-porodnických pracovištích. Z provedené literární rešerše byly vybrány a ohodnoceny skupinou odborníků vhodné ekonomicko-klinické efekty. Pomocí Saatyho metody byly stanoveny váhy kritérií a samotná matice byla otestována na konzistenci. Váhy kritérií byly použity v Analýze shody a neshody (CDA) pro multikriteriální hodnocení dvou přístupů k prenatální péči. Sběr nákladových dat pro ambulantní prenatální péči probíhal retrospektivně ve spolupráci s gynekologicko-porodnickou ambulantní ordinací v Libereckém kraji ČR. Nakonec byla vyhodnocena analýza nákladové efektivity, byl vypočten poměr inkrementálních nákladů a efektů (ICER) a provedena jednocestná citlivostní analýza. Celkové náklady ambulantní péče zahrnující náklady na monitorovací systém děložní aktivity z pohledu plátce jsou 200 276 Kč. Celkové náklady na skupinu těhotných pacientek se standardní prenatální péčí jsou 182 861 Kč. Na jednu vynaloženou peněžní jednotku dojde k získání 14,73 × 10-6 efektu u monitorované skupiny pacientek a 7,27 × 10-6 efektu u standardní skupiny pacientek. Analýza nákladové efektivity prokázala, že využití přístupu se systémem telemonitoringu v prenatální péči je výrazně nákladově efektivnější než standardní péče.
Currently new technologies are still being developed in order to constantly improve health care. Telemedicine is also in progress and is used in many fields. The aim of this study is to compare the telemonitoring system to a care, which is a standard approach in gynecological and obstetric facilities. Economic and clinical outcomes were selected from the conducted literary review and evaluated by a group of experts. The criteria weights were determinated with the help of the Saaty’s method and the matrix itself was tested for consistency. The criteria weights were applied in the Concordance Discordance Analysis (CDA), which was used for multi-criteria decision making of two approaches to prenatal care. Collecting of cost data for outpatient prenatal care was carried out retrospectively in cooperation with the gynecological-obstetric outpatient facility in Liberec Region in the Czech Republic. Finally, the cost effectiveness analysis was evaluated, the ratio of incremental costs and effects (ICER) was calculated and one-way sensitivity analysis was performed. The total costs of outpatient care, including the cost of uterine activity telemonitoring system, from the payer’s perspective are CZK 200 276. The total costs for a group of pregnant patients with standard ambulatory prenatal care are CZK 182 861. For one deployed money unit a 14,73 × 10-6 effect is obtained in a monitored patient group and a 7,27 × 10-6 effect in a standard patient group. Cost-effectiveness analysis showed that the use of a telemonitoring system in prenatal care is significantly more cost-effective than the standard care.
- MeSH
- ambulantní péče ekonomika MeSH
- diagnostické techniky porodnicko-gynekologické MeSH
- lidé MeSH
- monitorování činnosti dělohy ekonomika metody přístrojové vybavení MeSH
- monitorování plodu ekonomika metody přístrojové vybavení MeSH
- náklady a analýza nákladů ekonomika MeSH
- prenatální péče * ekonomika metody organizace a řízení MeSH
- těhotenství MeSH
- telemetrie ekonomika metody MeSH
- Check Tag
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
