Benefit, risks and cost-effectiveness of screening for abdominal aortic aneurysm.
OBJECTIVE
Abdominal aortic aneurysms (AAA) cause a considerable number of deaths. A ruptured AAA is associated with a mortality rate of 80%. The purpose of this study was to summarize the current evidence from published health economic models for the long-term effectiveness and cost-effectiveness of screening programs for AAA.


METHODS
Medical, economic and health technology assessment (HTA) databases were systematically searched for cost-effectiveness models up to October 2007. Only models with a lifetime time horizon of evaluating AAA screening in men over 65 years were included in the review. Study data were extracted, standardized and summarized in evidence tables and cost-effectiveness plots.


RESULTS
We reviewed 8 cost-effectiveness models published between 1993 and 2007 comparing AAA screening and lack of screening in men over 60. One model yielded a loss of life-years at additional costs. The remaining seven models yielded gains in life expectancy ranging from 0.02 to 0.28LYs. Gains in quality-adjusted life expectancy reported by six of the seven models ranged from 0.015 to 0.059 QALYs. Incremental costs ranged from 96 to 721 Euros. Incremental cost-effectiveness ratios (ICER) ranged from 1443 to 13 299 Euros per LY or QALY gained.


CONCLUSIONS
Based on our analysis, the introduction of a screening program to identify AAA will probably gain additional life years and quality of life at acceptable extra costs. The target population for a screening program should be men 65 years and older.
Schmidt
T
T
Public Health, UMIT.
Mühlberger
N
N
Chemelli-Steingruber
I E
IE
Strasak
A
A
Kofler
B
B
Chemelli
A
A
Siebert
U
U
D000367:Age Factors; D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000191:economics* / Q000401:mortality; D001019:Aortic Rupture / Q000175:diagnosis / Q000191:economics / Q000401:mortality; D003362:Cost-Benefit Analysis; D003952:Diagnostic Imaging / Q000191:economics*; D005858:Germany; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012737:Sex Factors