Cost-effectiveness of different screening strategies for abdominal aortic aneurysm.
OBJECTIVE
The primary objective of this study was to develop a simulation model to assess the cost-effectiveness of different screening strategies for abdominal aortic aneurysms (AAAs) in men.


METHODS
A systematic review of the literature was conducted for different screening strategies in terms of age (60, 65, or 70 years) and risk profiles (all men or specific high-risk groups) of the screened population, and rescreening after 5 or 10 years. These data were analyzed in a Markov simulation cohort model.


RESULTS
The cost per life year gained for different screening strategies ranged from US 8,309 dollars to US 14,084 dollars and was estimated at US 10,474 dollars when 65-year-old men were screened once. Screening 60-year-old men was equally cost-effective, with the advantage of more life years gained. We demonstrated a trade-off between high prevalence of AAA and lower life expectancy, eliminating the expected benefits of screening high-risk groups such as smokers (US 10,695 dollars) or cardiovascular patients (US 10,392 dollars). Assuming general population utility resulted in a cost per quality-adjusted life year (QALY) gained of US 13,900 dollars, whereas a hypothetical 5% reduction in utility among men with a screening-detected AAA raised the cost per QALY gained to US 75,100 dollars.


CONCLUSIONS
This Markov model, which was based on a systematic review of the literature, supplied information on the estimated cost-effectiveness of different screening strategies. Screening men for AAA may be cost-effective in the long-term. Different screening strategies and quality-of-life effects related to screening for AAA need to be evaluated in future clinical studies.
Wanhainen
Anders
A
Department of Surgery, Uppsala University Hospital, SE-371- 85 Uppsala, Sweden. andwan@algonet.se
Lundkvist
Jonas
J
Bergqvist
David
D
Björck
Martin
M
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000191:economics* / Q000601:surgery; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D011788:Quality of Life; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000191:economics*