title: Outcome of the Swedish Nationwide Abdominal Aortic Aneurysm Screening Program.
abstract: A general abdominal aortic aneurysm (AAA) screening program, targeting 65-year-old men, has gradually been introduced in Sweden since 2006 and reached nationwide coverage in 2015. The aim of this study was to determine the outcome of this program.
  
  
  
  Data on the number of invited and examined men, screening-detected AAAs, AAAs operated on, and surgical outcome were retrieved from all 21 Swedish counties for the years 2006 through 2014. AAA-specific mortality data were retrieved from the Swedish Cause of Death Registry. A linear regression analysis was used to estimate the effect on AAA-specific mortality among all men ≥65 years of age for the observed time period. The long-term effects were projected by using a validated Markov model.
  
  
  
  Of 302 957 men aged 65 years invited, 84% attended. The prevalence of screening-detected AAA was 1.5%. After a mean of 4.5 years, 29% of patients with AAA had been operated on, with a 30-day mortality rate of 0.9% (1.3% after open repair and 0.3% after endovascular repair, P<0.001). The introduction of screening was associated with a significant reduction in AAA-specific mortality (mean, 4.0% per year of screening, P=0.020). The number needed to screen and the number needed to operate on to prevent 1 premature death were 667 and 1.5, respectively. With a total population of 9.5 million, the Swedish national AAA-screening program was predicted to annually prevent 90 premature deaths from AAA and to gain 577 quality-adjusted life-years. The incremental cost-efficiency ratio was estimated to be €7770 per quality-adjusted life-years.
  
  
  
  Screening 65-year-old men for AAA is an effective preventive health measure and is highly cost-effective in a contemporary setting. These findings confirm the results from earlier randomized controlled trials and model studies in a large population-based setting of the importance for future healthcare decision making.
authors.affiliation: From Department of Surgical Sciences, Uppsala University, Sweden (A.W., M.B., S.S.); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (R.H.); Department of Surgery and Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden (A.L.); Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden (J.H., A.G.); Department of Vascular Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden (K.S., M.L.); and Department of Surgery, Falun County Hospital, Falun, Sweden (S.S.). anders.wanhainen@surgsci.uu.se.
authors.forename: Anders
authors.initials: A
authors.lastname: Wanhainen
authors.affiliation: From Department of Surgical Sciences, Uppsala University, Sweden (A.W., M.B., S.S.); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (R.H.); Department of Surgery and Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden (A.L.); Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden (J.H., A.G.); Department of Vascular Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden (K.S., M.L.); and Department of Surgery, Falun County Hospital, Falun, Sweden (S.S.).
authors.forename: Rebecka
authors.initials: R
authors.lastname: Hultgren
authors.affiliation: From Department of Surgical Sciences, Uppsala University, Sweden (A.W., M.B., S.S.); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (R.H.); Department of Surgery and Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden (A.L.); Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden (J.H., A.G.); Department of Vascular Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden (K.S., M.L.); and Department of Surgery, Falun County Hospital, Falun, Sweden (S.S.).
authors.forename: Anneli
authors.initials: A
authors.lastname: Linné
authors.affiliation: From Department of Surgical Sciences, Uppsala University, Sweden (A.W., M.B., S.S.); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (R.H.); Department of Surgery and Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden (A.L.); Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden (J.H., A.G.); Department of Vascular Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden (K.S., M.L.); and Department of Surgery, Falun County Hospital, Falun, Sweden (S.S.).
authors.forename: Jan
authors.initials: J
authors.lastname: Holst
authors.affiliation: From Department of Surgical Sciences, Uppsala University, Sweden (A.W., M.B., S.S.); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (R.H.); Department of Surgery and Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden (A.L.); Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden (J.H., A.G.); Department of Vascular Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden (K.S., M.L.); and Department of Surgery, Falun County Hospital, Falun, Sweden (S.S.).
authors.forename: Anders
authors.initials: A
authors.lastname: Gottsäter
authors.affiliation: From Department of Surgical Sciences, Uppsala University, Sweden (A.W., M.B., S.S.); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (R.H.); Department of Surgery and Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden (A.L.); Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden (J.H., A.G.); Department of Vascular Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden (K.S., M.L.); and Department of Surgery, Falun County Hospital, Falun, Sweden (S.S.).
authors.forename: Marcus
authors.initials: M
authors.lastname: Langenskiöld
authors.affiliation: From Department of Surgical Sciences, Uppsala University, Sweden (A.W., M.B., S.S.); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (R.H.); Department of Surgery and Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden (A.L.); Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden (J.H., A.G.); Department of Vascular Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden (K.S., M.L.); and Department of Surgery, Falun County Hospital, Falun, Sweden (S.S.).
authors.forename: Kristian
authors.initials: K
authors.lastname: Smidfelt
authors.affiliation: From Department of Surgical Sciences, Uppsala University, Sweden (A.W., M.B., S.S.); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (R.H.); Department of Surgery and Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden (A.L.); Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden (J.H., A.G.); Department of Vascular Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden (K.S., M.L.); and Department of Surgery, Falun County Hospital, Falun, Sweden (S.S.).
authors.forename: Martin
authors.initials: M
authors.lastname: Björck
authors.affiliation: From Department of Surgical Sciences, Uppsala University, Sweden (A.W., M.B., S.S.); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (R.H.); Department of Surgery and Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden (A.L.); Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden (J.H., A.G.); Department of Vascular Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden (K.S., M.L.); and Department of Surgery, Falun County Hospital, Falun, Sweden (S.S.).
authors.forename: Sverker
authors.initials: S
authors.lastname: Svensjö
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000453:epidemiology*; D002423:Cause of Death; D006801:Humans; D008403:Mass Screening / Q000379:methods; D009026:Mortality; D063868:Patient Outcome Assessment; D011159:Population Surveillance; D015995:Prevalence; D013548:Sweden / Q000453:epidemiology
keywords: aneurysm; aorta; cost-benefit analysis; prevention and control; screening; ultrasonography