Informing the efficient use of health care and health care research resources - the case of screening for abdominal aortic aneurysm in Sweden.
BACKGROUND
An analytical framework using Bayesian decision theory and value-of-information analysis has recently been advocated for the economic evaluation of health technologies. The purpose of this study was to apply this framework to screening for abdominal aortic aneurysm (AAA) in Sweden and to compare the conclusions from this study with the conclusions presented in an assessment performed by the Swedish Council of Technology Assessment (SBU).


METHODS
A probabilistic decision-analytical model was developed to establish the cost-effectiveness of a screening programme for AAA relative to current clinical practice and to calculate the value-of-information.


RESULTS
The cost per quality-adjusted life-year for screening was 9700 euro. The expected value of perfect information for the assessment of overall cost-effectiveness was low, suggesting little benefit in conducting further research. Expected value of perfect partial information indicated that rupture probabilities were associated with the highest uncertainty. By contrast, the SBU report concluded there was limited evidence of cost-effectiveness and proposed further research.


CONCLUSIONS
The investigated screening programme for AAA is likely to be cost-effective and conducting another clinical trial is unlikely to add much valuable information to this decision problem. These recommendations contrast with the vaguer recommendations from SBU that more evidence is required of costs-effectiveness.
Henriksson
Martin
M
Center for Medical Technology Assessment, Linköping University, Sweden. henriksson@ihs.liu.se
Lundgren
Fredrik
F
Carlsson
Per
P
D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis*; D003695:Delivery of Health Care; D017598:Efficiency, Organizational; D006302:Health Services Research; D008403:Mass Screening; D018803:Models, Economic; D013222:State Medicine; D013548:Sweden