Cost-effectiveness of screening for abdominal aortic aneurysm in the Netherlands and Norway

Spronk, Sandra; Kempen, Bob J.H. van; Boll, A.P.M.; Jørgensen, Jørgen J.; Hunink, M. G. Myriam; Kristiansen, Ivar Sønbø

doi:10.1002/bjs.7620

Cited by 41 publications

(32 citation statements)

References 61 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…76,78,79,100,101 Economic models that use age-specific population norms report values in the range 0.72-0.87. 80,[95][96][97][98]102,103 In all but one study 96 the values were derived from the European Quality of Life-5 Dimensions (EQ-5D). Table 34 reports the probability data used to estimate weighted average costs for those patients with a ruptured AAA and for the perioperative and postoperative costs of elective AAA repair and Tables 57 and 58 in Appendix 12 report the cost of events used in the economic model for the primary and sensitivity analyses.…”

Section: Economic Evaluation: Data Inputs and Resultsmentioning

confidence: 99%

“…76,78,79,100,101 The approach used in this evaluation is similar to that used in evaluations of the cost-effectiveness of screening and surveillance programmes for AAA. 80,[95][96][97][98]102,103 However, there are a number of limitations. The first is that published population norms aggregated utility values for age ranges, rather than by year of age.…”

Section: Economic Analysismentioning

confidence: 99%

See 1 more Smart Citation

Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation

Grant

Sperrin

Carlson

et al. 2015

Health Technology Assessment

View full text Add to dashboard Cite

BackgroundAbdominal aortic aneurysm (AAA) repair aims to prevent premature death from AAA rupture. Elective repair is currently recommended when AAA diameter reaches 5.5 cm (men) and 5.0 cm (women). Applying population-based indications may not be appropriate for individual patient decisions, as the optimal indication is likely to differ between patients based on age and comorbidities.ObjectiveTo develop an Aneurysm Repair Decision Aid (ARDA) to indicate when elective AAA repair optimises survival for individual patients and to assess the cost-effectiveness and associated uncertainty of elective repair at the aneurysm diameter recommended by the ARDA compared with current practice.Data sourcesThe UK Vascular Governance North West and National Vascular Database provided individual patient data to develop predictive models for perioperative mortality and survival. Data from published literature were used to model AAA growth and risk of rupture. The cost-effectiveness analysis used data from published literature and from local and national databases.MethodsA combination of systematic review methods and clinical registries were used to provide data to populate models and inform the structure of the ARDA. Discrete event simulation (DES) was used to model the patient journey from diagnosis to death and synthesised data were used to estimate patient outcomes and costs for elective repair at alternative aneurysm diameters. Eight patient clinical scenarios (vignettes) were used as exemplars. The DES structure was validated by clinical and statistical experts. The economic evaluation estimated costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) from the NHS, social care provider and patient perspective over a lifetime horizon. Cost-effectiveness acceptability analyses and probabilistic sensitivity analyses explored uncertainty in the data and the value for money of ARDA-based decisions. The ARDA outcome measures include perioperative mortality risk, annual risk of rupture, 1-, 5- and 10-year survival, postoperative long-term survival, median life expectancy and predicted time to current threshold for aneurysm repair. The primary economic measure was the ICER using the QALY as the measure of health benefit.ResultsThe analysis demonstrated it is feasible to build and run a complex clinical decision aid using DES. The model results support current guidelines for most vignettes but suggest that earlier repair may be effective in younger, fitter patients and ongoing surveillance may be effective in elderly patients with comorbidities. The model adds information to support decisions for patients with aneurysms outside current indications. The economic evaluation suggests that using the ARDA compared with current guidelines could be cost-effective but there is a high level of uncertainty.LimitationsLack of high-quality long-term data to populate all sections of the model meant that there is high uncertainty about the long-term clinical and economic consequences of repair. Modelling assumptions were necessary and the developed survival models require external validation.ConclusionsThe ARDA provides detailed information on the potential consequences of AAA repair or a decision not to repair that may be helpful to vascular surgeons and their patients in reaching informed decisions. Further research is required to reduce uncertainty about key data, including reintervention following AAA repair, and assess the acceptability and feasibility of the ARDA for use in routine clinical practice.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Section: Economic Evaluation: Data Inputs and Resultsmentioning

confidence: 99%

Section: Economic Analysismentioning

confidence: 99%

Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation

Grant

Sperrin

Carlson

et al. 2015

Health Technology Assessment

View full text Add to dashboard Cite

show abstract

“…A systematic review of the models to 2006 emphasised the variability in their estimates of cost-effectiveness. 57 Since that review, a number of further modelling studies have been published drawing on data from a variety of sources: for example studies relating to Italy, 15 to the Netherlands and Norway, 58 to Canada 59,60 and to Denmark. 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.…”

Section: Introductionmentioning

confidence: 99%

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

Thompson

Brown²,

Sweeting³

et al. 2013

Health Technology Assessment

184

177

View full text Add to dashboard Cite

This report should be referenced as follows:Thompson SG, Brown LC, Sweeting MJ, Bown MJ, Kim LG, Glover MJ, et al. Systematic review and meta-analysis of the growth and rupture rates of small abdominal aortic aneurysms: implications for surveillance intervals and their cost-effectiveness. Health Technol Assess 2013;17(41). Health Technology Assessment is indexed in MEDLINE, CINAHL, EMBASE, The Cochrane Library and the ISI Science Citation Index and is assessed for inclusion in the Database of Abstracts of Reviews of Effects. Health Technology Assessment is indexed and abstracted inThis journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: www.hta.ac.uk/ This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 08/30/02. The contractual start date was in November 2009. The draft report began editorial review in July 2012 and was accepted for publication in November 2012. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research...

show abstract

“…[46][47][48] AAA screening was cost effective, with an incremental cost-efficiency ratio of less than US$30 000 per qualityadjusted life-year gained. 22 A recent report on outcomes of the Swedish nationwide screening program concluded that screening for AAA remains cost effective, despite declining prevalence and a shift to more expensive procedures.…”

Section: Resource Usementioning

confidence: 99%

Recommendations on screening for abdominal aortic aneurysm in primary care

2017

CMAJ

View full text Add to dashboard Cite

KEY POINTS• Pooled analyses from four population-based RCTs with men older than 65 years show that one-time screening with ultrasonography for AAA reduces the risk of aneurysm-related death, rupture and emergency repair.• Screening leads to identification of aneurysms that would not dilate or rupture, and increases the likelihood of elective repair procedures for these patients.• A weak recommendation in favour of screening suggests the importance of shared decision-making with the primary care provider and patient, with discussion of patient preferences for screening.• The prevalence of AAA in screened populations has declined since the RCTs were conducted, reducing the absolute benefit of screening.• Women have much lower rates of AAA than men, and there is no direct evidence that screening women has a positive impact on their health.• Evidence on the impact of AAA screening on men older than 80 years of age is indirect, meaning any potential benefit is uncertain. CPD

show abstract

Cost-effectiveness of screening for abdominal aortic aneurysm in the Netherlands and Norway

Abstract: Using this model, screening for AAA in 65-year-old men would be highly cost-effective in both the Netherlands and Norway.

Cited by 41 publications

References 61 publications

Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation

Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation

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

Recommendations on screening for abdominal aortic aneurysm in primary care

Contact Info

Product

Resources

About