The cost-effectiveness of a "quick-screen" program for abdominal aortic aneurysms.
BACKGROUND
The incidence of abdominal aortic aneurysm (AAA) is increasing, and the prognosis of ruptured AAA remains dismal. Early diagnosis and intervention are crucial. We designed this study to determine whether selected population screening with a brief "quick-screen" ultrasound could be cost-effective.


METHODS
A series of 25 patients with risk factors for AAA were evaluated in a blinded fashion by a quick-screen ultrasound and a full conventional study. Times and accuracy for the 2 approaches were compared. An analysis of the cost-effectiveness of screening for AAA was then performed using a Markov model. We determined the long-term survival in quality-adjusted life years and lifetime costs for a hypothetical cohort of 70-year-old males undergoing either AAA screening or not. Our measure of outcome was the cost-effectiveness ratio (CER).


RESULTS
The average time for a quick screen was one-sixth that of a conventional study (4 vs 24 minutes). The accuracy of the quick screen was 100%. In our base-case analysis, screening for AAA was cost-effective with a CER of $11,215. Society usually is willing to pay for interventions with CER of less than $60,000 (eg, CER for coronary artery bypass grafting, $9500; breast cancer screening, $16,000). In sensitivity analysis, reducing the cost of screening from $259 (approximate Medicare reimbursement) to $40 (the quick screen) improved the CER to $6850. Moreover, screening populations with increased prevalence of AAA (eg, male with family history [18%]) further improved the CER.


CONCLUSIONS
Our analysis demonstrates that ultrasound screening for AAA should be offered to all males above the age of 60. Widespread screening for AAA should be adopted and reimbursed by Medicare and other insurers.
Lee
Thomas Y
TY
Department of Surgery (Division of Vascular Surgery), Weill Medical College of Cornell University, New York Presbyterian Hospital, New York 10021, USA.
Korn
Peter
P
Heller
Jennifer A
JA
Kilaru
Sashi
S
Beavers
Frederick P
FP
Bush
Harry L
HL
Kent
K Craig
KC
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000453:epidemiology; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000453:epidemiology; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000191:economics*