Cost Effectiveness of Abdominal Aortic Aneurysm Screening and Rescreening in Men in a Modern Context: Evaluation of a Hypothetical Cohort Using a Decision Analytical Model

Overview

Journal BMJ

Specialty General Medicine

Date 2012 Jul 7

PMID 22767630

Citations 10

Authors

Rikke Sogaard

Jesper Laustsen

Jes S Lindholt

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the cost effectiveness of different screening strategies for abdominal aortic aneurysm in men, from the perspective of a national health service.

Setting: Screening units at regional hospitals.

Participants: Hypothetical cohort of 65 year old men from the general population.

Main Outcome Measures: Costs (£ in 2010) and effect on health outcomes (quality adjusted life years (QALYs)).

Results: Screening seems to be highly cost effective compared with not screening. The model estimated a 92% probability that some form of screening would be cost effective at a threshold of £20,000 (€24,790; $31,460). If men with an aortic diameter of 25-29 mm at the initial screening were rescreened once after five years, 452 men per 100,000 initially screened would benefit from early detection, whereas lifetime rescreening every five years would detect 794 men per 100,000. We estimated the associated incremental cost effectiveness ratios for rescreening once and lifetime rescreening to be £10,013 and £29,680 per QALY, respectively. The individual probability of being the most cost effective strategy was higher for each rescreening strategy than for the screening once strategy (in view of the £20,000 threshold).

Conclusions: This study confirms the cost effectiveness of screening versus no screening and lends further support to considerations of rescreening men at least once for abdominal aortic aneurysm.

Citing Articles

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Lindholt J, Diederichsen A, Rasmussen L, Frost L, Steffensen F, Lambrechtsen J Clin Epidemiol. 2020; 12:95-103.

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Thorbjornsen K, Svensjo S, Gidlund K, Gilgen N, Wanhainen A Ups J Med Sci. 2019; 124(3):180-186.

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Dahl M, Frost L, Sogaard R, Klausen I, Lorentzen V, Lindholt J BMC Cardiovasc Disord. 2018; 18(1):20.

PMID: 29402233 PMC: 5800093. DOI: 10.1186/s12872-018-0758-8.

References

Lindholt J, Vammen S, Fasting H, Henneberg E . Psychological consequences of screening for abdominal aortic aneurysm and conservative treatment of small abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 2000; 20(1):79-83. DOI: 10.1053/ejvs.1999.1087. View

Vardulaki K, Prevost T, Walker N, Day N, Wilmink A, Quick C . Growth rates and risk of rupture of abdominal aortic aneurysms. Br J Surg. 1999; 85(12):1674-80. DOI: 10.1046/j.1365-2168.1998.00946.x. View

Brown P, Zelt D, Sobolev B . The risk of rupture in untreated aneurysms: the impact of size, gender, and expansion rate. J Vasc Surg. 2003; 37(2):280-4. DOI: 10.1067/mva.2003.119. View

Lindholt J, Sorensen J, Sogaard R, Henneberg E . Long-term benefit and cost-effectiveness analysis of screening for abdominal aortic aneurysms from a randomized controlled trial. Br J Surg. 2010; 97(6):826-34. DOI: 10.1002/bjs.7001. View

Sweeting M, Thompson S . Making predictions from complex longitudinal data, with application to planning monitoring intervals in a national screening programme. J R Stat Soc Ser A Stat Soc. 2012; 175(2):569-586. PMC: 3412214. DOI: 10.1111/j.1467-985X.2011.01005.x. View

Sorensen J, Davidsen M, Gudex C, Pedersen K, Bronnum-Hansen H . Danish EQ-5D population norms. Scand J Public Health. 2009; 37(5):467-74. DOI: 10.1177/1403494809105286. View

Ashton H, Buxton M, Day N, Kim L, Marteau T, Scott R . The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet. 2002; 360(9345):1531-9. DOI: 10.1016/s0140-6736(02)11522-4. View

Ades A, Lu G, Claxton K . Expected value of sample information calculations in medical decision modeling. Med Decis Making. 2004; 24(2):207-27. DOI: 10.1177/0272989X04263162. View

Silverstein M, Pitts S, Chaikof E, Ballard D . Abdominal aortic aneurysm (AAA): cost-effectiveness of screening, surveillance of intermediate-sized AAA, and management of symptomatic AAA. Proc (Bayl Univ Med Cent). 2005; 18(4):345-67. PMC: 1255946. DOI: 10.1080/08998280.2005.11928095. View

10.

Kent K . Endovascular aneurysm repair--is it durable?. N Engl J Med. 2010; 362(20):1930-1. DOI: 10.1056/NEJMe1004299. View

11.

Lindholt J, Juul S, Fasting H, Henneberg E . Screening for abdominal aortic aneurysms: single centre randomised controlled trial. BMJ. 2005; 330(7494):750. PMC: 555873. DOI: 10.1136/bmj.38369.620162.82. View

12.

Thompson S, Ashton H, Gao L, Scott R . Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ. 2009; 338:b2307. PMC: 3272658. DOI: 10.1136/bmj.b2307. View

13.

Metcalfe D, Holt P, Thompson M . The management of abdominal aortic aneurysms. BMJ. 2011; 342:d1384. DOI: 10.1136/bmj.d1384. View

14.

Scott R, Thompson S . Screening, surgical repair, and the management of abdominal aortic aneurisms. J Med Screen. 2005; 12(2):57-8. DOI: 10.1258/0969141053908339. View

15.

Lederle F, Johnson G, Wilson S, Ballard D, Jordan Jr W, Blebea J . Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair. JAMA. 2002; 287(22):2968-72. DOI: 10.1001/jama.287.22.2968. View

16.

Lindholt J, Sorensen J . [Hospital costs for abdominal aortic aneurysm surgery]. Ugeskr Laeger. 2010; 172(33):2206-12. View

17.

Powell J, Sweeting M, Brown L, Gotensparre S, Fowkes F, Thompson S . Systematic review and meta-analysis of growth rates of small abdominal aortic aneurysms. Br J Surg. 2011; 98(5):609-18. DOI: 10.1002/bjs.7465. View

18.

Grondal N, Sogaard R, Henneberg E, Lindholt J . The Viborg Vascular (VIVA) screening trial of 65-74 year old men in the central region of Denmark: study protocol. Trials. 2010; 11:67. PMC: 2891736. DOI: 10.1186/1745-6215-11-67. View

19.

Wanhainen A, Lundkvist J, Bergqvist D, Bjorck M . Cost-effectiveness of different screening strategies for abdominal aortic aneurysm. J Vasc Surg. 2005; 41(5):741-51. DOI: 10.1016/j.jvs.2005.01.055. View

20.

Montreuil B, Brophy J . Screening for abdominal aortic aneurysms in men: a Canadian perspective using Monte Carlo-based estimates. Can J Surg. 2008; 51(1):23-34. PMC: 2386296. View