Mass screening on abdominal aortic aneurysm in men aged 60 to 65 years in The Netherlands. Impact on life expectancy and cost-effectiveness using a Markov model.
OBJECTIVE
To predict the costs and effects on life expectancy of an AAA screening programme.


METHODS
A Markov model was designed to compare the effects of a single screening for a cohort of men 60-65 years with the current no screening strategy. The following health states were distinguished: no AAA, unknown small AAA, follow-up small AAA, unknown large AAA, repaired AAA, rejected large AAA and death. Transition rates between the health states were simulated using cycle times of one year. Transition probabilities were derived from literature and a previous feasibility study. Incremental costs per life year saved were calculated. Sensitivity analyses and discounting for future effects were performed.


RESULTS
The expected individual AAA costs for non-screening and AAA screening were euro; 196 and euro; 530 respectively. A difference of 3.5 months life expectancy was found in favour of screening leading to euro; 1176/life-year gained. Costs increased as compliance fell. With a discount rate of 4% the costs are euro; 2021/life-year gained.


CONCLUSIONS
One-time ultrasonographic screening for AAA in men aged 60-65 years appears to be cost-effective.
Boll
A P M
AP
Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.
Severens
J L
JL
Verbeek
A L M
AL
van der Vliet
J A
JA
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000191:economics / Q000453:epidemiology; D003362:Cost-Benefit Analysis; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D015233:Models, Statistical; D009426:Netherlands / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D014463:Ultrasonography / Q000191:economics