Screening for abdominal aortic aneurysm in 65-year-old men remains cost-effective with contemporary epidemiology and management.
OBJECTIVE
The epidemiology and management of abdominal aortic aneurysms (AAA) has changed significantly, with lower prevalence, increased longevity of patients, increased use of endovascular aneurysm repair (EVAR), and improved outcome. The clinical and health economic effectiveness of one-time screening of 65-year-old men was assessed within this context.


METHODS
One-time ultrasound screening of 65-year-old men (invited) versus no screening (control) was analysed in a Markov model. Data on the natural course of AAA (risk of repair and rupture) was based on randomised controlled trials. Screening detected AAA prevalence (1.7%), surgical management (50% EVAR), repair outcome, costs, and long-term survival were based on contemporary population-based data. Incremental cost-efficiency ratios (ICER), absolute and relative risk reduction for death from AAA (ARR, RRR), numbers needed to screen (NNS), and life-years gained were calculated. Annual discounting was 3.5%.


RESULTS
In base case at 13-years follow-up the ICER was €14,706 per incremental quality-adjusted life-year (QALY); ARR was 15.1 per 10,000 invited, NNS was 530, and QALYs gained were 56.5 per 10,000 invited. RRR was 42% (from 0.36% in control to 0.21% in invited). In a lifetime analysis the ICER of screening decreased to €7,570/QALY. The parameters with highest impact on the cost-efficiency of screening in the sensitivity analysis were the prevalence of AAA (threshold value <0.5%) and degree of incidental detection in the control cohort.


CONCLUSIONS
In the face of recent changes in the management and epidemiology of AAA, screening men for AAA remains cost-effective and delivers significant clinical impact.
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, 75185 Uppsala, Sweden; Department of Surgery, Falun County Hospital, Falun, Sweden. Electronic address: sverker.svensjo@ltdalarna.se.
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S
Svensjö
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, 75185 Uppsala, Sweden.
K
K
Mani
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, 75185 Uppsala, Sweden.
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M
Björck
Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
J
J
Lundkvist
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, 75185 Uppsala, Sweden.
A
A
Wanhainen
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000191:economics* / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D001019:Aortic Rupture / Q000191:economics / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
Abdominal aortic aneurysm; Cost-effectiveness; Mass screening