title: Screening individuals with intracranial aneurysms for abdominal aortic aneurysms is cost-effective based on estimated coprevalence.
abstract: Aneurysm rupture is a major cause of morbidity and mortality, and evidence suggests shared risk for both abdominal aortic aneurysms (AAAs) and intracranial aneurysms (IAs). We hypothesized that screening for AAA in patients with known IA is cost-effective.
  
  
  
  We used a decision tree model to compare costs and outcomes of AAA screening vs no screening in a hypothetical cohort of patients with IA. We measured expected outcomes using quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratio (ICER). We performed a Monte Carlo simulation and additional sensitivity analyses to assess the effects of ranging base case variables on model outcomes and identified thresholds where a decision alternative dominated the model (both less expensive and more effective than the alternative).
  
  
  
  In our base case analysis, screening for AAA provided an additional 0.17 QALY (2.5-97.5 percentile: 0.11-0.27 QALY) at a saving of $201 (2.5-97.5 percentile: $-127 to $896). This yielded an ICER of $-1150/QALY (2.5-97.5 percentile: $-4299 to $6374/QALY), that is, screening saves $1150 per QALY gained.
  
  
  
  Based on this model, screening for AAA in individuals with IA is cost-effective at an ICER of $1150/QALY, well below accepted societal thresholds estimated at $60,000/QALY. Cost-effectiveness of cross-screening in these populations is sensitive to aneurysm coprevalence and risk of rupture. Further prospective study is warranted to validate this finding.
authors: Department of Neurology, University of Virginia, Charlottesville, Va.
authors: Benjamin Z
authors: BZ
authors: Ball
authors: Department of Neurology, University of Virginia, Charlottesville, Va.
authors: Boxiang
authors: B
authors: Jiang
authors: Department of Neurology, University of Virginia, Charlottesville, Va.
authors: Prachi
authors: P
authors: Mehndiratta
authors: Department of Public Health Sciences, University of Virginia, Charlottesville, Va.
authors: George J
authors: GJ
authors: Stukenborg
authors: Department of Surgery, University of Virginia, Charlottesville, Va.
authors: Gilbert R
authors: GR
authors: Upchurch
authors: Department of Neurology, Mayo Clinic, Jacksonville, Fla.
authors: James F
authors: JF
authors: Meschia
authors: Department of Neurology, University of Virginia, Charlottesville, Va; Department of Public Health Sciences, University of Virginia, Charlottesville, Va. Electronic address: bbw9r@virginia.edu.
authors: Bradford B
authors: BB
authors: Worrall
authors: Department of Neurology, University of Virginia, Charlottesville, Va; Department of Public Health Sciences, University of Virginia, Charlottesville, Va.
authors: Andrew M
authors: AM
authors: Southerland
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000191:economics* / Q000453:epidemiology / Q000601:surgery; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000191:economics / Q000453:epidemiology; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D003952:Diagnostic Imaging / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000191:economics / Q000453:epidemiology; D008403:Mass Screening / Q000191:economics*; D018803:Models, Economic; D009010:Monte Carlo Method; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D014656:Vascular Surgical Procedures / Q000191:economics