Is population screening for abdominal aortic aneurysm cost-effective?

Abstract

BackgroundRuptured abdominal aortic aneurysm (AAA) is responsible for 1–2% of all male deaths over the age of 65 years. Early detection of AAA and elective surgery can reduce the mortality risk associated with AAA. However, many patients will not be diagnosed with AAA and have therefore an increased death risk due to the untreated AAA. It has been suggested that population screening for AAA in elderly males is effective and cost-effective. The purpose of this study was to perform a systematic review of published cost-effectiveness analyses of screening elderly men for AAA.MethodsWe performed a systematic search for economic evaluations in NHSEED, EconLit, Medline, Cochrane, Embase, Cinahl and two Scandinavian HTA data bases (DACEHTA and SBU). All identified studies were read in full and each study was systematically assessed according to international guidelines for critical assessment of economic evaluations in health care.ResultsThe search identified 16 cost-effectiveness studies. Most studies considered only short term cost consequences. The studies seemed to employ a number of "optimistic" assumptions in favour of AAA screening, and included only few sensitivity analyses that assessed less optimistic assumptions.ConclusionFurther analyses of cost-effectiveness of AAA screening are recommended.

Abdominal Aortic Aneurysm in Patients with Coronary Artery Disease: A Review Article

“…On the contrary, an elective AAA repair, recommended in most patients with an abdominal aortic diameter exceeding 50-55 mm or rapid growth (> 1 cm/y), is associated with a mortality risk of 2% to 6% (Kurvers at al., 2003;Sakalihasan et al, 2005). Health organizations recently recommended one-time screening for AAA by ultrasonography for men aged between 65 and 75 years with a smoking history, thereby reducing AAA related mortality rates by 50% (Cosford & Leng, 2007;Ehlers et al, 2008;Ferket et al, 2011;Moxon et al, 2010;Takagi et al, 2010). However, they advised against screening in men below 65 and over 75 years, and in women, since the number of AAArelated deaths that can be prevented by screening these populations is too small.…”

Abdominal Aortic Aneurysm (AAA): The Decision Pathway in Ruptured and Non-Ruptured AAA

“…Ehlers concluded 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 (Ehlers et al, 2008). These findings still need careful consideration in judging whether a co-coordinated population-based screening program should be introduced.…”

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

“…These findings did not suggest any major general differences in health care between the groups as a result of screening (S.G. Thompson et al, 2009). In addition, economic evaluations did not incorporate evidence that the lives of tobacco smokers are generally shorter than those of the general population (> 90% of patients with AAA have a history of smoking) (Ehlers et al, 2008). MASS found an association between AAA death and participation in the AAA screening program, but life-style issues were not controlled.…”

“…How the quality of ultrasonography influences the cost effectiveness of screening programs has to be carefully monitored. In all published decision analytic models of AAA screening, patients with an AAA  5.5 cm were assumed to face a constant probability of rupture no matter how many years they have had a large AAA (Ehlers et al, 2008). If all men are screened in the year that they turn 65 the calculated number of gained life years due to screening could be overestimated as the age of males dying of ruptured AAA is well over 65 years (72.4 % of men who died in 2009 of ruptured AAA in England and Wales were  75 years old, see above).…”