{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T03:12:02Z","timestamp":1784949122698,"version":"3.55.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T00:00:00Z","timestamp":1725321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Lower limb peripheral arterial disease in the symptomatic stage has a significant effect on patients\u00b4 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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\u2019s (QALY\u2019s). 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1367447","type":"journal-article","created":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T04:37:01Z","timestamp":1725338221000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Cost-effectiveness of diagnostic imaging modalities in symptomatic patients with lower limb peripheral arterial disease: discrete event simulation model"],"prefix":"10.3389","volume":"12","author":[{"given":"Vojt\u011bch","family":"Kamensk\u00fd","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladim\u00edr","family":"Rogalewicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ond\u0159ej","family":"Gajdo\u0161","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gleb","family":"Donin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbora","family":"Ma\u0161kov\u00e1","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Hol\u00e1","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ale\u0161","family":"Tichop\u00e1d","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,9,3]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1509","DOI":"10.1161\/CIRCRESAHA.116.303849","article-title":"Epidemiology of peripheral artery disease","volume":"116","author":"Criqui","year":"2015","journal-title":"Circ Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"S5","DOI":"10.1016\/j.jvs.2006.12.037","article-title":"Inter-society consensus for the Management of Peripheral Arterial Disease (TASC II)","volume":"45","author":"Norgren","year":"2007","journal-title":"J Vasc Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1038\/nrcardio.2016.179","article-title":"Peripheral artery disease: epidemiology and global perspectives","volume":"14","author":"Fowkes","year":"2017","journal-title":"Nat Rev Cardiol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e686","DOI":"10.1161\/CIR.0000000000000470","article-title":"2016 AHA\/ACC guideline on the Management of Patients with Lower Extremity Peripheral Artery Disease: executive summary: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines","volume":"135","author":"Gerhard-Herman","year":"2017","journal-title":"Circulation"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2356","DOI":"10.3390\/diagnostics13142356","article-title":"Focus on the Most common Paucisymptomatic Vasculopathic population, from diagnosis to secondary prevention of complications","volume":"13","author":"Martelli","year":"2023","journal-title":"Diagnostics"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1093\/eurheartj\/ehx095","article-title":"2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS)","volume":"39","author":"Aboyans","year":"2018","journal-title":"Eur Heart J"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1161\/CIRCIMAGING.111.970814","article-title":"Multimodality imaging of lower extremity peripheral arterial disease: current role and future directions","volume":"5","author":"Pollak","year":"2012","journal-title":"Circ Cardiovasc Imaging"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"11792","DOI":"10.3390\/ijerph191811792","article-title":"Discrete event simulation model for cost-effectiveness evaluation of screening for asymptomatic patients with lower extremity arterial disease","volume":"19","author":"Kamensk\u00fd","year":"2022","journal-title":"IJERPH"},{"key":"ref9","volume-title":"RStudio: Integrated development environment for R [internet]","year":"2021"},{"key":"ref10","year":"2021"},{"key":"ref11","first-page":"499","article-title":"Surgical treatment of peripheral circulation disorders","volume":"21","author":"Fontaine","year":"1954","journal-title":"Helv Chir Acta"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"619","DOI":"10.1177\/0272989X20932145","article-title":"How to address uncertainty in health economic discrete-event simulation models: an illustration for chronic obstructive pulmonary disease","volume":"40","author":"Corro Ramos","year":"2020","journal-title":"Med Decis Mak"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"475","DOI":"10.3109\/07853890.2014.932618","article-title":"Systematic reviews and meta-analyses for more profitable strategies in peripheral artery disease","volume":"46","author":"Di Minno","year":"2014","journal-title":"Ann Med"},{"key":"ref14","article-title":"SP-CAU-028 - W: Postup pro posuzov\u00e1n\u00ed anal\u00fdzy n\u00e1kladov\u00e9 efektivity. St\u00e1tn\u00ed \u00dastav pro Kontrolu L\u00e9\u010div","year":"2022"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1177\/0272989X12454579","article-title":"Model transparency and validation: a report of the ISPOR-SMDM modeling good research practices task force\u20137","volume":"32","author":"Eddy","year":"2012","journal-title":"Med Decis Mak"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1177\/0272989X12458348","article-title":"Model parameter estimation and uncertainty analysis: a report of the ISPOR-SMDM modeling good research practices task force working group\u20136","volume":"32","author":"Briggs","year":"2012","journal-title":"Med Decis Mak"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e012652","DOI":"10.1136\/bmjopen-2016-012652","article-title":"Cost-effectiveness of anatomical and functional test strategies for stable chest pain: public health perspective from a middle-income country","volume":"7","author":"Bertoldi","year":"2017","journal-title":"BMJ Open"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1016\/j.jval.2012.07.008","article-title":"Whole disease modeling to inform resource allocation decisions in Cancer: a methodological framework","volume":"15","author":"Tappenden","year":"2012","journal-title":"Value Health"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1148\/radiology.194.3.7862975","article-title":"Cost-effectiveness of MR angiography in cases of limb-threatening peripheral vascular disease","volume":"194","author":"Yin","year":"1995","journal-title":"Radiology"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1097\/01.RVI.0000052291.26939.82","article-title":"Pretreatment imaging workup for patients with intermittent claudication: a cost-effectiveness analysis","volume":"14","author":"Visser","year":"2003","journal-title":"J Vasc Interv Radiol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1148\/radiol.2273020441","article-title":"Cost-effectiveness targets for multi\u2013detector row CT angiography in the work-up of patients with intermittent claudication","volume":"227","author":"Visser","year":"2003","journal-title":"Radiology"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1053\/ejvs.2002.1838","article-title":"Cost-effectiveness of diagnostic imaging work-up and treatment for patients with intermittent claudication in the Netherlands","volume":"25","author":"Visser","year":"2003","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"iii-iv, xi-xiii, 1-184","DOI":"10.3310\/hta11200","article-title":"A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic, lower limb peripheral arterial disease","volume":"1","author":"Collins","year":"2007","journal-title":"Health Technol Assess"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1186\/1471-2458-14-89","article-title":"Screen or not to screen for peripheral arterial disease: guidance from a decision model","volume":"14","author":"Vaidya","year":"2014","journal-title":"BMC Public Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1177\/1358863X17745371","article-title":"Cost-effectiveness analysis of asymptomatic peripheral artery disease screening with the ABI test","volume":"23","author":"Itoga","year":"2018","journal-title":"Vasc Med"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1016\/j.ejvs.2021.02.039","article-title":"Clinical benefit, harm, and cost effectiveness of screening men for peripheral artery disease: a Markov model based on the VIVA trial","volume":"61","author":"Lindholt","year":"2021","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"v-vi, 1-192","DOI":"10.3310\/hta17580","article-title":"Economic modelling of diagnostic and treatment pathways in National Institute for health and care excellence clinical guidelines: the modelling algorithm pathways in guidelines (MAPGuide) project","volume":"17","author":"Lord","year":"2013","journal-title":"Health Technol Asses"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"542","DOI":"10.1016\/j.jval.2013.02.012","article-title":"Using whole disease modeling to inform resource allocation decisions: economic evaluation of a clinical guideline for colorectal Cancer using a single model","volume":"16","author":"Tappenden","year":"2013","journal-title":"Value Health"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3310\/hta18100","article-title":"Enhancements to angioplasty for peripheral arterial occlusive disease: systematic review, cost-effectiveness assessment and expected value of information analysis","volume":"18","author":"Simpson","year":"2014","journal-title":"Health Technol Assess"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1001\/jama.1995.03530020083037","article-title":"Revascularization for femoropopliteal disease. A decision and cost-effectiveness analysis","volume":"274","author":"Hunink","year":"1995","journal-title":"JAMA"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e013460","DOI":"10.1136\/bmjopen-2016-013460","article-title":"Cost-effectiveness of superficial femoral artery endovascular interventions in the UK and Germany: a modelling study","volume":"7","author":"Kearns","year":"2017","journal-title":"BMJ Open"},{"key":"ref32","article-title":"Z\u00e1kony pro lidi. 428\/2020 Sb. Vyhl\u00e1\u0161ka o stanoven\u00ed hodnot bodu, v\u00fd\u0161e \u00fahrad hrazen\u00fdch slu\u017eeb a regula\u010dn\u00edch omezen\u00ed pro rok","year":"2021"},{"key":"ref33","article-title":"St\u00e1tn\u00ed \u00fastav pro kontrolu l\u00e9\u010div","year":""},{"key":"ref34","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1007\/s10198-018-0955-5","article-title":"Population norms for the EQ-5D-3L: a cross-country analysis of population surveys for 20 countries","volume":"20","author":"Janssen","year":"2019","journal-title":"Eur J Health Econ"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/j.jvs.2004.11.022","article-title":"Comparison of generic and disease-specific questionnaires for the assessment of quality of life in patients with peripheral arterial disease","volume":"41","author":"de Vries","year":"2005","journal-title":"J Vasc Surg"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1017\/S0266462300009430","article-title":"A cost-utility analysis of laser-assisted angioplasty for peripheral arterial occlusions","volume":"12","author":"Sculpher","year":"1996","journal-title":"Int J Technol Assess Health Care"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1367447\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,3]],"date-time":"2024-09-03T04:37:04Z","timestamp":1725338224000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1367447\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,3]]},"references-count":36,"alternative-id":["10.3389\/fpubh.2024.1367447"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1367447","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,3]]},"article-number":"1367447"}}