Decision-analytical model with lifetime estimation of costs and health outcomes for one-time screening for abdominal aortic aneurysm in 65-year-old men

Henriksson, Martin; Lundgren, Fredrik

doi:10.1002/bjs.5122

Cited by 39 publications

(56 citation statements)

References 49 publications

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“…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%

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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

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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.

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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

“…These demonstrate acceptable costs in terms of quality adjusted life years (QALYs) gained by screening, both in urban and rural areas (Multicentre aneurysm screening group 2002, Henricksson 2005). The additional cost was found to be £63.39 per patient and the projected cost per life year gained after ten years was £8000.…”

Section: Screeningmentioning

confidence: 98%

“…The main cause o f aneurysm related death is rupture. In the UK, about 6000 men die from ruptured AAA every year, and this amounts to approximately 2% o f men over the age o f 65 years (Eamshaw 2005, Henricksson 2005). The mean incidence of ruptured aneurysm is also increasing.…”

Section: Mortalitymentioning

confidence: 99%

The role of the CCR5 Δ32 polymorphism in abdominal aortic aneurysms

Sandford¹,

Bown²,

London³

et al. 2009

Int J Immunogenetics

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All rights reserved INFORMATION TO ALL U SE R S The quality of this reproduction is d ep endent upon the quality of the copy submitted.In the unlikely event that the author did not sen d a com plete manuscript and there are m issing p a g es, th e se will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI U 526187Published by ProQ uest LLC 2013. Copyright in the Dissertation held by the Author. Microform Edition © ProQ uest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode. ProQ uest LLC 789 East Eisenhow er Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 ST A TEM EN T O F O R IG IN A LIT YI hereby declare that the work contained in this thesis is entirely my own, except where acknowledged, and has not been submitted for a degree to this or any other University. R.M.Sandford A B ST R A C T The Role o f the CCR5 A 32 Polymorphism in Abdominal Aortic Aneurysms By R.M.SandfordC-C Chemokine receptor 5 (CCR5) is involved in the regulation o f the inflammatory response. Abdominal aortic aneurysms (AAA) may arise as the result o f a chronic inflammatory process which is influenced by a genetic predisposition. The CCR5 gene harbours a 32 base pair deletion (the A32 polymorphism, rs333). The aim o f this study was to investigate the role o f the CCR5 A32 polymorphism in the development of AAA.A case control study was conducted including 285 patients with AAA and 273 control subjects. A blood sample was taken from each individual and DNA extracted. CCR5 genotype was determined using the polymerase chain reaction (PCR). Flow cytometry was used to investigate the biological activity o f the A32 polymorphism.There was no significant difference between the AAA and the control group in relation to the A32 allele frequency (AAA group 10%, control group 12%, P=0.82, chi squared analysis). There was also no significant difference in CCR5 genotype between groups (wild type homozygotes 82% in AAA group vs 77% in control group, heterozygotes 16% in AAA group vs 21% in control group, and A32 homozygotes 2% in both groups, P=0.33, chi squared analysis). The polymorphism was shown to be biologically active with the number o f A32 alleles correlating with cell expression of CCR5 as detected with flow cytometry (P=<0.05).This study demonstrates that the CCR5 A32 is a biologically active genetic polymorphism, however, there is no association between this polymorphism and AAA. Firstly, to Professor Rob Sayers for allowing me the opportunity to undertake this research and also for his supervision and support throughout the project. P U B L IC A T IO N S A R IS IN G FROM T H IS T H E S ISSandford DM Diabetes Mellitus DNAAlso, to Mr M iff Bown for his friendship, patience and encouragement in addition to providing statistical and scientific support. Demographic data 103 Table 7.2: Patient and control subject co-morbidity 105 Table 7.3: Patient and control group medication 106 Table 7.4: Univariate analysis of demog...

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“…For 65---year---old men specifically, the prevalence has previously been calculated to be 4.9% (Henriksson, Lundgren 2005a).…”

Section: Prevalence and Epidemiologymentioning

confidence: 99%

Abdominal Aortic Aneurysm : Aspects on how to affect mortality from rupture

Hager¹

2014

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Decision-analytical model with lifetime estimation of costs and health outcomes for one-time screening for abdominal aortic aneurysm in 65-year-old men

Abstract: A financially and practically feasible screening programme for AAA, in which men are invited for ultrasonography in the year in which they turn 65, appears to yield positive health outcomes at a reasonable cost.

Cited by 39 publications

References 49 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

The role of the CCR5 Δ32 polymorphism in abdominal aortic aneurysms

Abdominal Aortic Aneurysm : Aspects on how to affect mortality from rupture

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