Analysis of cost effectiveness of screening Danish men aged 65 for abdominal aortic aneurysm

Abstract

Objective To assess the cost effectiveness of screening men aged 65 for abdominal aortic aneurysm. Design Cost effectiveness analysis based on a probabilistic, enhanced economic decision analytical model from screening to death. Population and setting Hypothetical population of men aged 65 invited (or not invited) for ultrasound screening in the Danish healthcare system. Data sources Published results from randomised trials and observational epidemiological studies retrieved from electronic bibliographic databases, and supplementary data obtained from the Danish Vascular Registry. Data synthesis A hybrid decision tree and Markov model was developed to simulate the short term and long term effects of screening for abdominal aortic aneurysm compared with no systematic screening on clinical and cost effectiveness outcomes. Probabilistic sensitivity analyses using Monte Carlo simulation were carried out. Results were presented in a cost effectiveness acceptability curve, an expected value of perfect information curve, and a curve showing the expected (net) number of avoided deaths from abdominal aortic aneurysm over time after the introduction of screening. The model was validated by calibrating base case health outcomes and expected activity levels against evidence from the recent Cochrane review of screening for abdominal aortic aneurysm. Results The estimated costs per quality adjusted life year (QALY) gained discounted at 3% per year over a lifetime for costs and QALYs was £43 485 (€54 852; $71 160). At a willingness to pay threshold of £30 000 the probability of screening for abdominal aortic aneurysm being cost effective was less than 30%. One way sensitivity analyses showed the incremental cost effectiveness ratio varying from £32 640 to £66 001 per QALY. Conclusion Screening for abdominal aortic aneurysm does not seem to be cost effective. Further research is needed on long term quality of life outcomes and costs.

Systematic review and meta-analysis of the growth and rupture rates of small abdominal aortic aneurysms: implications for surveillance intervals and their cost-effectiveness

“…61 These have all concluded that screening is acceptably cost-effective, with the exception of a study using data from Denmark and other sources, which concluded that screening did not seem to be cost-effective. 62 A recent modelling study, again using Danish data, contradicts that previous conclusion, suggesting that screening men at age 65 years is highly cost-effective compared with no screening and, additionally, that rescreening after 5 years may be a cost-effective extension to the programme. 63 However, no models of cost-effectiveness of AAA screening have been published that have specific relevance to NAAASP, other than those already cited relating to and derived from the MASS study, which is the largest randomised trial of AAA screening and contributes most to the international evidence.…”

The Abdominal Aortic Aneurysm – Prognosis, Treatment, Screening and Cost-Effectiveness

“…In the long-term run screening was found to be even more cost effective, at a probability above 0.97 for a willingness to pay threshold of Euro 5000 (Lindholt et al, 2010). In contrast, the cost effectiveness of screening Danish men aged 65 for AAA was rejected by Ehlers et al, 2009a. They developed a decision tree and Markov model to simulate the short-term and long-term effects of screening for AAA.…”

“…This latter approach will benefit from a higher prevalence of AAA and thus show a better cost effectiveness (Ehlers et al 2009b). Ehlers et al, 2009a emphasized that ultrasonography may be cheap on a per person basis, but screening is not just a test but a program. If screening is to be effective then overall administration of the program, operational planning, a communication strategy, a quality assurance system, and more are needed.…”

“…A possible reason for the discrepancy between this study and that by S.G. Thompson et al, 2009 might be that the MASS results (S.G. Thompson et al, 2009) reflect a sample group screened at age 65-74. Ehlers et al, 2009a, however, have directly modeled the effects of the current policy of inviting men aged 65 to participate in a screening program, what is fundamentally different from a one-time screening of all elderly men (Buxton, 2009;Ehlers et al 2009b). This latter approach will benefit from a higher prevalence of AAA and thus show a better cost effectiveness (Ehlers et al 2009b).…”

Using Proteomics to Understand Abdominal Aortic Aneurysms: Where Are We?

“…The diameter of the AAA reflects the magnitude of the degenerative process of the wall and this is a marker of rupture. Therefore, the need for additional strategies to refine cost effectiveness of screening programs is currently advocated [7]. AAA is a multifactorial disease.…”