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

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

The COVID-19 epidemic has spread across the world within months and creates multiple challenges for healthcare providers. Patients with cardiovascular disease represent a vulnerable population when suffering from COVID-19. Most hospitals have been facing difficulties in the treatment of COVID-19 patients, and there is a need to minimise patient flow time so that staff health is less endangered, and more patients can be treated. This article shows how to use simulation techniques to prepare hospitals for a virus outbreak. The initial simulation of the current processes of the heart clinic first identified the bottlenecks. It confirmed that the current workflow is not optimal for COVID-19 patients; therefore, to reduce waiting time, three optimisation scenarios are proposed. In the best situation, the discrete-event simulation of the second scenario led to a 62.3% reduction in patient waiting time. This is one of the few studies that show how hospitals can use workflow modelling using timed coloured Petri nets to manage healthcare systems in practice. This technique would be valuable in these challenging times as the health of staff, and other patients are at risk from the nosocomial transmission.

• MeSH
• Betacoronavirus MeSH
• COVID-19 MeSH
• kardiologie organizace a řízení   MeSH
• koronavirové infekce * MeSH
• lidé MeSH
• pandemie * MeSH
• počítačová simulace MeSH
• průběh práce * MeSH
• SARS-CoV-2 MeSH
• virová pneumonie * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Cryoballoon ablation for treatment of atrial fibrillation (AF) reduces procedure times, but limited data is available about its impact on electrophysiology (EP) lab efficiency in Central and Eastern Europe (CEE). Using CEE-specific procedure data, the present study modeled cryoballoon ablation procedures on EP lab resource consumption to improve efficiency. METHODS: A discrete event simulation model was developed to assess EP efficiency with cryoballoon ablation. Model inputs were taken from CEE sites within the Cryo Global Registry, namely Czech Republic, Hungary, Poland, Serbia, and Slovakia. The main endpoints were percentage of days that resulted in overtime and percentage of days with time for one extra simple EP procedure. Use of the 'figure of 8' (Fo8) closure technique to reduce procedure time was also examined. RESULTS: The mean lab occupancy time across all CEE sites was 133 ± 47 minutes (min: 104 minutes, max:181 minutes). Cryoballoon ablation in the base-case scenario resulted in 14.6% of days with overtime and 64.8% of days with time for an extra simple EP procedure. Use of the Fo8 closure technique enhanced these values to 5.5% and 85.3%, respectively. Model endpoints were most sensitive to changes in lab occupancy times and overtime start time. CONCLUSIONS: In this CEE-specific analysis of EP lab efficiency it was found that 3 cryoballoon ablation procedures could be performed in 1 lab day, leaving time for a 4th simple EP procedure on most days. As such, use cryoballoon ablation for PVI is an effective way to improve EP lab efficiency.

• MeSH
• časové faktory MeSH
• délka operace MeSH
• elektrofyziologické techniky kardiologické MeSH
• fibrilace síní * chirurgie   patofyziologie   diagnóza   MeSH
• kryochirurgie * MeSH
• lidé MeSH
• registrace * MeSH
• venae pulmonales * chirurgie   patofyziologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• východní Evropa MeSH

• MeSH
• matematika MeSH
• teorie her MeSH
• Publikační typ
• monografie MeSH

• Konspekt
• Matematika
• NLK Obory
• přírodní vědy

• MeSH
• fyzikální chemie MeSH
• Publikační typ
• monografie MeSH

• Konspekt
• Fyzikální chemie
• NLK Obory
• chemie, klinická chemie

• MeSH
• krevní transfuze MeSH
• medicína v divočině MeSH
• resuscitace MeSH
• transfuzní lékařství MeSH
• vojenské lékařství MeSH
• Publikační typ
• kongresy MeSH
• sborníky MeSH
• zprávy MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• hematologie a transfuzní lékařství
• urgentní lékařství

• MeSH
• chování MeSH
• molekulární biologie MeSH
• nemoci nervového systému MeSH
• nervový systém MeSH
• neurochemie MeSH
• neurofyziologie MeSH
• neurony MeSH
• neurovědy MeSH
• Publikační typ
• monografie MeSH

• Konspekt
• Fyziologie člověka a srovnávací fyziologie
• NLK Obory
• neurovědy
• biologie