title: An economic evaluation of an abdominal aortic aneurysm screening program in Italy.
abstract: OBJECTIVE
  Abdominal aortic aneurysm (AAA) is defined as a localized dilatation of an aortic vessel. Though predominantly asymptomatic, it is a chronic degenerative condition associated with life-threatening risk of rupture. The early diagnosis of AAA, ie, before it ruptures, is therefore important; a simple, effective diagnostic method is ultrasound examination. To assess the benefit of screening in Italy, we developed a cost-effective Markov model comparing screening vs nonscreening scenarios.
  
  
  METHODS
  A 13-health-states Markov model was developed to compare two cohorts of 65- to 75-year-old men: the first group undergoing screening for AAA by means of ultrasound (US), the second following the current practice of incidental detection. The following health states were distinguished: no AAA, unknown small AAA (3-3.9 cm), followed-up small AAA (1 year), unknown medium-sized AAA (4-4.9 cm), followed-up medium-sized AAA (6 months), unknown large AAA (>5 cm), elective repair, emergency repair, postelective-repair AAA, postemergency-repair AAA, rejected large AAA, and death. Transitions between health states were simulated by using 6-month cycles. Transition probabilities were derived from a literature review of relevant randomized controlled trial and from a screening program that is currently ongoing at San Martino Hospital in Genoa, Italy. The Italian National Health Service (NHS) perspective was adopted and incremental cost per life-year saved was calculated with a lifetime horizon; costs and health benefits were discounted at an annual rate of 3% from year 2 onward. Uncertainty surrounding the model inputs was tested by means of univariate, multivariate, and probabilistic sensitivity analyses.
  
  
  RESULTS
  Considering an attendance rate of 62%, the individual cost per invited subject was €60 (US $83.2); 0.011 additional quality adjusted life years (QALY) were gained per patient in the screened cohort, corresponding to an incremental cost-effectiveness ratio (ICER) of €5673/QALY (US $7870/QALY). The results were sensitive to some parameter variations but consistent with the base case scenario. They suggest that on the basis of a willingness-to-pay threshold of €50,000/QALY, screening for AAA is cost-effective, with a probability approaching 100%.
  
  
  CONCLUSIONS
  As in economic evaluations developed in other countries, such as the UK, Canada, and The Netherlands, setting up a screening program for AAA can be considered cost-effective from the Italian NHS perspective.
authors.affiliation: Medtronic Italia S.p.A., Sesto San Giovanni (MI), Italy. stefano.giardina@medtronic.com
authors.forename: Stefano
authors.initials: S
authors.lastname: Giardina
authors.forename: Bianca
authors.initials: B
authors.lastname: Pane
authors.forename: Giovanni
authors.initials: G
authors.lastname: Spinella
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cafueri
authors.forename: Mara
authors.initials: M
authors.lastname: Corbo
authors.forename: Pascale
authors.initials: P
authors.lastname: Brasseur
authors.forename: Giovanni
authors.initials: G
authors.lastname: Orengo
authors.forename: Domenico
authors.initials: D
authors.lastname: Palombo
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000191:economics* / Q000601:surgery; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D007558:Italy; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D018803:Models, Economic; D009313:National Health Programs / Q000191:economics*; D011237:Predictive Value of Tests; D011379:Prognosis; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D014463:Ultrasonography; D014656:Vascular Surgical Procedures / Q000191:economics