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 MeSH

OBJECTIVES: Human papillomavirus (HPV) infections are highly prevalent sexually transmitted infections, notably associated with various cancers. This study analyses the health and economic impacts of HPV-associated diseases in the Czech Republic and evaluates the cost-effectiveness of a catch-up vaccination program. METHODS: Utilizing a Markov multistate model, the study assesses the lifetime impacts and costs related to HPV infections. Cohorts of ages 15-21 were simulated to assess the impact of catch-up vaccination outside the 11-year-old age group. RESULTS: The total quality-adjusted life years (QALYs) for the female and male cohorts (together 119,362 individuals) were higher in the vaccination scenario compared to the non-vaccination scenario. The increase in QALYs was 122,246 and 200,852 respectively, when considering the actual vaccination rates. Across both cohorts, 329 cancer-related deaths were prevented. In the probabilistic sensitivity analysis for the female population, vaccination was the dominant strategy in 99.3% of iterations. In the male population, vaccination was the dominant strategy in 80.3% of iterations. The implementation of catch-up vaccination for the 15-21 age group significantly increased QALY gains and reduced life-years-lost (LYLs). In the female cohort, all analysed rates of catch-up vaccination were the dominant strategy, while in the male cohort, the incremental cost-effectiveness ratios (ICERs) remained consistently below 42,000 CZK/QALY. CONCLUSIONS: The catch-up vaccination program for 15-21-year-olds is cost-effective and can prevent a significant number of HPV-related cancers in both men and women.

• MeSH
• analýza nákladové efektivity MeSH
• analýza nákladů a výnosů * MeSH
• dospělí MeSH
• infekce papilomavirem * prevence a kontrola   ekonomika   MeSH
• kvalitativně upravené roky života * MeSH
• lidé MeSH
• Markovovy řetězce * MeSH
• mladiství MeSH
• mladý dospělý MeSH
• očkovací programy ekonomika   MeSH
• osobní újma zaviněná nemocí MeSH
• vakcíny proti papilomavirům * ekonomika   aplikace a dávkování   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

Aterosklerózou podmíněná kardiovaskulární onemocnění (ASKVO) představují hlavní příčinu morbidity a mortality nejen v České republice, ale také globálně. Ze jejich hlavní, tedy kauzální rizikový faktor (RF) je považován cholesterol nesený částicemi obsahujícími apolipoprotein B (apoB), tj. převážně částicemi LDL. Jakkoli je věnována stále větší pozornost inovativním léčebným postupům, ukazuje se, že za nedostatečnou kontrolou dyslipidemie (DLP) stojí často nonadherence k léčbě či (bohužel) lékařská inercie. Cílem multicentrické retrospektivní průřezové studie bylo zmapování kontroly DLP a léčebných strategií ve skupině pacientů ve vysokém či velmi vysokém kardiovaskulárním (KV) riziku, a to na pracovištích ambulantních kardiologů/internistů. Celkem bylo do studie zařazeno 450 pacientů – 80 % ve velmi vysokém KV-riziku a 12,7 % v KV-riziku vysokém; zbylá procenta zaujímali chybně zařazení probandi. Pouze 19,4 % velmi vysoce KV-rizikových nemocných, respektive 28,1 % vysoce rizikových, dosahovalo cílových hodnot LDL-cholesterolu (LDL-C). Více než 60 % ošetřujících kardiologů (navzdory doporučeným postupům) preferovalo pomalou (opatrnou) titraci dávky hypolipidemik; pouze 17 % kliniků indikovalo promptní úpravu zavedené terapie (navýšení dávky, změnu preparátu či přidání dalšího léku) k dosažení redukce LDL-C. Překvapujícím zjištěním bylo, že přes 60 % lékařů bylo spokojeno s dosavadní léčbou, a to i přes to, že nebylo dosaženo cílových hodnot lipidových parametrů. Je zřejmá velmi pozvolná (bohužel neuspokojivá) penetrace doporučených postupů do klinické praxe. Lze tedy předpokládat, že při maximálním využití v současnosti dostupných léčebných možností bude u velké části pacientů docíleno uspokojivé kontroly DLP, a to s minimem dalších nákladů.

Atherosclerotic cardiovascular diseases (ASCVD) are the leading cause of morbidity and mortality not only in the Czech Republic but also globally. Cholesterol carried by apolipoprotein B (apoB)-containing particles, i.e. predominantly LDL particles, is considered to be their major, i.e. causal, risk factor (RF). Although increasing attention is being paid to innovative therapies, it appears that nonadherence to treatment or (unfortunately) medical inertia is often behind the lack of control of dyslipidemia (DLP). The aim of this multicenter retrospective cross-sectional study was to map DLP control and treatment strategies in a group of patients at high or very high cardiovascular (CV) risk, in outpatient cardiologists/internists’ offices. A total of 450 patients were enrolled in the study-80% at very high CV risk and 12.7% at high CV risk; the remaining percentages were misclassified probands. Only 19.4% and 28.1% of the very high CV-risk and high-risk patients, respectively, achieved target LDL-cholesterol (LDL-C) levels. More than 60% of the treating cardiologists (despite recommended practices) preferred slow (cautious) dose titration of hypolipidemic agents; only 17% of clinicians indicated prompt modification of established therapy (dose increase, change of preparation, or addition of another drug) to achieve LDL-C reduction. A surprising finding was that over 60% of clinicians were satisfied with the current treatment, despite not achieving target lipid parameters. A very slow (unfortunately unsatisfactory) penetration of the recommended procedures into clinical practice is evident. Thus, it can be assumed that with maximum use of currently available treatment options, satisfactory control of DLP will be achieved in a large proportion of patients with minimal additional costs.

• MeSH
• adherence k farmakoterapii statistika a číselné údaje   MeSH
• dyslipidemie etiologie   farmakoterapie   MeSH
• hypolipidemika terapeutické užití   MeSH
• kardiovaskulární nemoci * etiologie   farmakoterapie   MeSH
• LDL-cholesterol * krev   účinky léků   MeSH
• lidé středního věku MeSH
• lidé MeSH
• rizikové faktory kardiovaskulárních chorob MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• klinická studie MeSH
• multicentrická studie MeSH
• pozorovací studie 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.

• 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 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.

• 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

INTRODUCTION: Leber hereditary optic neuropathy (LHON) is the most commonly diagnosed mitochondrial disorder, resulting in colour vision abnormalities and rapid but painless deterioration of central vision. While numerous studies have assessed the impact of LHON on the quality of life (QoL) of LHON patients, the financial impact of the disease remains unexplored. This study attempts to calculate both the direct non-medical costs and the indirect costs associated with productivity losses experienced by people with LHON and their unpaid caregivers in Slovenia, in addition to assessing their QoL. Due to the rarity of the disease, the study involved a small sample size, which is important to note for interpreting the results. METHODS: The analysis was conducted on nine adult participants diagnosed with LHON, representing one-third of the total number of known Slovenian patients with this condition. To thoroughly assess the economic and social impact of LHON, tailored questionnaires were designed to collect information on demographics, socioeconomic status, LHON severity, and associated non-medical and indirect costs. RESULTS: The mean age of the study participants was 48.8 years (SD 13.3; n = 9). The annual productivity loss attributable to LHON, taking both absenteeism and relative presenteeism into account, was calculated to be EUR 11,608 per person affected. The mean VFQ-25 score, a measure of vision-related quality of life, for adult LHON patients was 30.4 (SD 12.9). CONCLUSION: The findings highlight the significant economic and social burden of LHON on patients and their families. Ensuring prompt, accurate diagnosis, access to treatment, financial support, and psychological counselling and services are critical to helping individuals cope with and mitigate the profound challenges of vision loss and living with LHON.

• MeSH
• dospělí MeSH
• kvalita života * MeSH
• Leberova atrofie zrakového nervu * ekonomika   MeSH
• lidé středního věku MeSH
• lidé MeSH
• osobní újma zaviněná nemocí MeSH
• průzkumy a dotazníky MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Slovinsko MeSH

• MeSH
• dostupnost zdravotnických služeb MeSH
• hodnotící studie jako téma MeSH
• lidé MeSH
• řízení zdravotnictví MeSH
• ukazatele kvality zdravotní péče * organizace a řízení   MeSH
• výběr pacientů MeSH
• zajištění kvality zdravotní péče metody   organizace a řízení   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• novinové články MeSH

INTRODUCTION: Leber hereditary optic neuropathy (LHON) is the most frequent mitochondrial disease causing dyschromatopsia and progressive central visual loss that is subacute in progression and painless. Several studies have been published assessing QoL in patients with LHON, but no estimate of the economic burden has been reported to date. This study aims to quantify direct non-medical and indirect costs (productivity loss) incurred by LHON patients and their informal caregivers in Czechia and Slovakia, as well as to assess their quality of life. METHODS: The study was performed in 27 adults and children with LHON. To determine the socioeconomic burden of LHON, separate questionnaires for adults, children, and their parents were developed, including demographic and socioeconomic data. The following data were collected: age, education, family size, severity of LHON, non-medical direct and indirect costs of LHON. RESULTS: The mean age of adult respondents was 36.1 years (SD 13.1; n = 21). The total cost of absenteeism was EUR 1003 per person/year in adult employees, and EUR 2711 per person/year in children's parents. The productivity loss as a consequence of LHON due to combined relative absenteeism and relative presenteeism was estimated at EUR 9840 per an adult patient/year, and EUR 6298 per a parent/year, respectively. The mean cost of informal care was estimated at EUR 4502 (SD 4772; n = 6) per person/year. The mean VFQ-25 score for adult patients with LHON was 43.47 (SD 15.86). CONCLUSION: The results of this study clearly show that patients with LHON and their families face an extensive socioeconomic burden related to this rare disease. Early, timely and appropriate access to diagnosis, treatment, and reimbursement decisions, but also to psychological counselling and services may help the patients and their relatives adapt and cope with the challenging aspects of vision loss and life with the disease.

• Publikační typ
• časopisecké články MeSH

• Klíčová slova
• cesta pacienta,
• MeSH
• adherence pacienta MeSH
• dodržení předchozích instrukcí MeSH
• management péče o pacienta * MeSH
• mezioborová komunikace MeSH
• plánování péče o pacienty MeSH
• prodromální symptomy MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) MeSH
• Publikační typ
• novinové články MeSH

BACKGROUND: Inhaled corticosteroids have been widely reported as a preventive measure against the development of severe forms of COVID-19 not only in patients with asthma. METHODS: In 654 Czech and Slovak patients with asthma who developed COVID-19, we investigated whether the correct use of inhaler containing corticosteroids was associated with a less severe course of COVID-19 and whether this had an impact on the need for hospitalisation, measurable lung functions and quality of life (QoL). RESULTS: Of the studied cohort 51.4% had moderate persistent, 29.9% mild persistent and 7.2% severe persistent asthma. We found a significant adverse effect of poor inhaler adherence on COVID-19 severity (p=0.049). We also observed a lower hospitalisation rate in patients adequately taking the inhaler with OR of 0.83. Vital capacity and forced expiratory lung volume deterioration caused by COVID-19 were significantly reversed, by approximately twofold to threefold, in individuals who inhaled correctly. CONCLUSION: Higher quality of inhalation technique of corticosteroids measured by adherence to an inhaled medication application technique (A-AppIT) score had a significant positive effect on reversal of the vital capacity and forced expiratory lung volume in 1 s worsening (p=0.027 and p<0.0001, respectively) due to COVID-19. Scoring higher in the A-AppIT was also associated with significantly improved QoL. All measured variables concordantly and without exception showed a positive improvement in response to better adherence. We suggest that corticosteroids provide protection against the worsening of lungs in patients with COVID-19 and that correct and easily assessable adherence to corticosteroids with appropriate inhalation technique play an important role in preventing severe form of COVID-19.

• MeSH
• bronchiální astma * farmakoterapie   MeSH
• COVID-19 * MeSH
• hormony kůry nadledvin MeSH
• kvalita života MeSH
• lidé MeSH
• usilovný výdechový objem MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH