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
• Cost-Benefit Analysis * MeSH
• Computed Tomography Angiography economics   statistics & numerical data   MeSH
• Diagnostic Imaging economics   statistics & numerical data   MeSH
• Angiography, Digital Subtraction * economics   MeSH
• Lower Extremity * diagnostic imaging   MeSH
• Ultrasonography, Doppler, Duplex economics   MeSH
• Quality-Adjusted Life Years * MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Angiography economics   MeSH
• Peripheral Arterial Disease * diagnostic imaging   economics   MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article 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
• Amputation, Surgical MeSH
• Cost-Benefit Analysis MeSH
• Lower Extremity MeSH
• Quality-Adjusted Life Years MeSH
• Humans MeSH
• Vascular Diseases * MeSH
• Mass Screening * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article 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
• Cardiology organization & administration   MeSH
• Coronavirus Infections * MeSH
• Humans MeSH
• Pandemics * MeSH
• Computer Simulation MeSH
• Workflow * MeSH
• SARS-CoV-2 MeSH
• Pneumonia, Viral * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't 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
• Time Factors MeSH
• Operative Time MeSH
• Electrophysiologic Techniques, Cardiac MeSH
• Atrial Fibrillation * surgery   physiopathology   diagnosis   MeSH
• Cryosurgery * MeSH
• Humans MeSH
• Registries * MeSH
• Pulmonary Veins * surgery   physiopathology   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe, Eastern MeSH

• MeSH
• Mathematics MeSH
• Game Theory MeSH
• Publication type
• Monograph MeSH

• Conspectus
• Matematika
• NML Fields
• přírodní vědy

• MeSH
• Blood Transfusion MeSH
• Wilderness Medicine MeSH
• Resuscitation MeSH
• Transfusion Medicine MeSH
• Military Medicine MeSH
• Publication type
• Congress MeSH
• Collected Work MeSH
• News MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• hematologie a transfuzní lékařství
• urgentní lékařství

• MeSH
• Chemistry, Physical MeSH
• Publication type
• Monograph MeSH

• Conspectus
• Fyzikální chemie
• NML Fields
• chemie, klinická chemie

• MeSH
• Behavior MeSH
• Molecular Biology MeSH
• Nervous System Diseases MeSH
• Nervous System MeSH
• Neurochemistry MeSH
• Neurophysiology MeSH
• Neurons MeSH
• Neurosciences MeSH
• Publication type
• Monograph MeSH

• Conspectus
• Fyziologie člověka a srovnávací fyziologie
• NML Fields
• neurovědy
• biologie