Cost-effectiveness of the National Health Service abdominal aortic aneurysm screening programme in England

Abstract

BackgroundImplementation of the National Health Service abdominal aortic aneurysm (AAA) screening programme (NAAASP) for men aged 65 years began in England in 2009. An important element of the evidence base supporting its introduction was the economic modelling of the long-term cost-effectiveness of screening, which was based mainly on 4-year follow-up data from the Multicentre Aneurysm Screening Study (MASS) randomized trial. Concern has been expressed about whether this conclusion of cost-effectiveness still holds, given the early performance parameters, particularly the lower prevalence of AAA observed in NAAASP.MethodsThe existing published model was adjusted and updated to reflect the current best evidence. It was recalibrated to mirror the 10-year follow-up data from MASS; the main cost parameters were re-estimated to reflect current practice; and more robust estimates of AAA growth and rupture rates from recent meta-analyses were incorporated, as were key parameters as observed in NAAASP (attendance rates, AAA prevalence and size distributions).ResultsThe revised and updated model produced estimates of the long-term incremental cost-effectiveness of £5758 (95 per cent confidence interval £4285 to £7410) per life-year gained, or £7370 (£5467 to £9443) per quality-adjusted life-year (QALY) gained.ConclusionAlthough the updated parameters, particularly the increased costs and lower AAA prevalence, have increased the cost per QALY, the latest modelling provides evidence that AAA screening as now being implemented in England is still highly cost-effective.

Meta-Analysis of the Current Prevalence of Screen-Detected Abdominal Aortic Aneurysm in Women

“…If AAA screening in 65-year-old men is cost-effective down to a prevalence rate as low as 0⋅35 per cent 39 , AAA screening also may be cost-effective in 70-year-old women, especially as the AAA rupture rate in women is about four times that in men for a given AAA diameter 40 . Indeed, a modelling study from Sweden 41 has already suggested that AAA screening for older women would be cost-effective, based on an AAA prevalence of 1⋅1 per cent in 65-year-old women.…”

Sex differences in mortality after abdominal aortic aneurysm repair in the UK

“…31 to 51) per cent)1, and is highly cost‐effective2. As a result, AAA screening in men aged 65 years was fully implemented across England and Wales in 2013, and is now established across the UK.…”

Patients with Small Abdominal Aortic Aneurysm are at Significant Risk of Cardiovascular Events and this Risk is not Addressed Sufficiently

“…The long latent period between development of AAA and rupture offers an opportunity for screening which has been shown to reduce AAA-related mortality in men by detecting aneurysms prior to rupture and offering elective surgical repair to prevent rupture (2). Screening reduces AAA-related mortality by 50% and has been shown to be cost effective, even at low AAA prevalence rates (2)(3)(4). Nationwide AAA screening programmes have subsequently been introduced across the United Kingdom (UK), Sweden, in some regions of Denmark and in the United States (US) Veterans' Association.…”