Screening for familial intracranial aneurysm: resource implications.
In this descriptive study, we estimate the resource implications of screening 18-65 year-old first degree relatives of patients with a first degree family history of intracranial aneurysm (IA). A postal survey of 374 patients who underwent operative clipping of IA between July 1994 and June 1997 was performed, enquiring about first degree family history of IA and first degree family structure. The response rate was 68.2% (255/374). Thirty-five out of 255 patients (14.0%) reported IAs in first degree relatives and 21 (8.2%) in second degree relatives giving a total of 57 (22.0%) with a reported family history. The average number of screenable relatives currently living in Ireland was 5.6 per high-risk family. Assuming a national prevalence of 0.45% for ruptured IA, these data give a point prevalence for high-risk families of 816 in the Republic of Ireland (1996 census population 3.6 x 10(6). Thus, the number of currently screenable relatives (5.6 per family) is 4814. A 15% yield has previously been reported from screening of first degree relatives in Northern Ireland. A national screening programme should thus detect over 700 individuals with asymptomatic IAs. The time required to screen the screenable population once would be 2.3 years by digital subtraction angiography (DSA) and 1.1 years by magnetic resonance angiography (MRA). In order to detect de novo aneurysms, screening has been suggested in this suspect population at 6-monthly to 5-yearly intervals after the initial study. In the absence of a biological marker, the results of our survey suggest that screening for familial IA disease would pose a significant logistical burden and have major financial implications for health care services.
Roberts
G
G
Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland.
Nanra
J
J
Phillips
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D003625:Data Collection; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics*; D007494:Ireland / Q000453:epidemiology; D018810:Magnetic Resonance Angiography / Q000379:methods; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D010375:Pedigree; D011177:Postal Service; D015995:Prevalence