Abdominal aortic aneurysm screening: how many life years lost from underuse of the medicare screening benefit?
BACKGROUND
Since 2007, Medicare has provided one-time abdominal aortic aneurysm (AAA) screening for men with smoking history, and men and women with a family history of AAA as part of its Welcome to Medicare visit.


OBJECTIVE
We examined utilization of the new AAA screening benefit and estimated how increased utilization could influence population health as measured by life years gained. Additionally, we explored the impact of expanding screening to women with smoking history.


METHODS
Analysis of Medicare claims and a simulation model to estimate the effects of screening, using published data for parameter estimates.


METHODS
AAA screening in the primary care setting.


METHODS
Newly-enrolled Medicare beneficiaries aged 65 years, with smoking history or family history of AAA.


METHODS
Life expectancy, 10-year survival rates.


RESULTS
Medicare data revealed low utilization of AAA screening, under 1% among those eligible. We estimate that screening could increase life expectancy per individual invited to screening for men with smoking history (0.11 years), with family history of AAA (0.17 years), and women with family history (0.08 years), and smoking history (0.09 years). Average gains of 131 life years per 1,000 persons screened for AAA compare favorably with the grade B United States Preventive Services Task Force (USPSTF) recommendation for breast cancer screening, which yields 95-128 life years per 1,000 women screened. These findings were robust over a range of scenarios.


CONCLUSIONS
The simulation results reflect assumptions regarding AAA prevalence, treatment, and outcomes in specific populations based on published research and US survey data. Published data on women were limited.


CONCLUSIONS
The Welcome to Medicare and AAA screening benefits have been underutilized. Increasing utilization of AAA screening would yield substantial gains in life expectancy. Expanding screening to women with smoking history also has the potential for substantial health benefits.
Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA, nolchanski@tuftsmedicalcenter.org.
N
N
Olchanski
A
A
Winn
J T
JT
Cohen
P J
PJ
Neumann
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000401:mortality* / Q000517:prevention & control; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008017:Life Expectancy / Q000639:trends*; D008297:Male; D008403:Mass Screening / Q000639:trends*; D006278:Medicare / Q000639:trends*; D008875:Middle Aged; D012907:Smoking / Q000401:mortality; D000074606:Smoking Prevention; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology