Laura Rees Willett, MD, FACP
What is the long-term cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men 65 to 74 years of age?
Cost-effectiveness analysis from a UK health service perspective based on 10-year follow-up of a randomized controlled trial (Multicentre Aneurysm Screening Study [MASS]). Current Controlled Trials ISRCTN37381646.
4 centers in the UK.
Population-based sample of 67 770 men 65 to 74 years of age.
33 883 men received an invitation to screening for AAA. If an aneurysm ≥ 3 cm was detected, men were rescanned every 3 months or annually depending on the size of the aneurysm; men were referred for elective surgery for aneurysms ≥ 5.5 cm or that expanded by ≥ 1 cm/y, or if symptoms were reported. 33 887 men received no invitation to screening.
Deaths related to AAA and costs (invitation and reinvitation to screening, initial scan, recall scan, referral for elective surgery, elective surgery, and emergency surgery).
27 204 men (80%) in the invited group attended screening, and 1334 aneurysms ≥ 3 cm were detected. Mortality related to AAA was lower in the invited group at 10 years (Table). The incremental cost-effectiveness ratio was £7600 (95% CI 5100 to 13 000) per life-year gained.
Screening men 65 to 74 years of age for abdominal aortic aneurysm (AAA) reduced AAA-related mortality and was cost-effective at 10-year follow-up.
Invitation to screening for abdominal aortic aneurysm (AAA) vs no invitation (control) in a population-based sample of men 65 to 74 years of age*
*NNS = number needed to screen; other abbreviations defined in Glossary. RRR, NNS, and CI calculated from hazard ratios in article.
†Based on deaths related to AAA, adjusted for other causes.
‡£1.00 = $1.65. Costs based on 2000 to 2001 prices adjusted to reflect 2008 to 2009 prices. Costs and survival are discounted at 3.5%/y.
Willett LR. Screening for abdominal aortic aneurysm (AAA) in men 65 to 74 years of age was cost-effective for AAA mortality at 10 years. Ann Intern Med. ;151:JC5–15. doi: 10.7326/0003-4819-151-10-200911170-02015
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Published: Ann Intern Med. 2009;151(10):JC5-15.
Emergency Medicine, Healthcare Delivery and Policy.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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