Screening for Abdominal Aortic Aneurysm in 65-Year-old Men Remains Cost-effective with Contemporary Epidemiology and Management

被引:87
作者
Svensjo, S. [1 ,2 ]
Mani, K. [1 ]
Bjorck, M. [1 ]
Lundkvist, J. [3 ]
Wanhainen, A. [1 ]
机构
[1] Uppsala Univ, Dept Surg Sci, Vasc Surg Sect, S-75185 Uppsala, Sweden
[2] Falun Cty Hosp, Dept Surg, SE-79182 Falun, Sweden
[3] Karolinska Inst, Med Management Ctr, Stockholm, Sweden
基金
瑞典研究理事会;
关键词
Abdominal aortic aneurysm; Cost-effectiveness; Mass screening; OCCULT BLOOD-TEST; FOLLOW-UP; CARDIOVASCULAR-DISEASE; CANCER MORTALITY; BREAST-CANCER; REPAIR; TRIAL; BENEFIT; IMPACT;
D O I
10.1016/j.ejvs.2013.12.023
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objectives: 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 (sic)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 (sic)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. (C) 2014 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:357 / 365
页数:9
相关论文
共 50 条
[1]   Mortality Results from a Randomized Prostate-Cancer Screening Trial [J].
Andriole, Gerald L. ;
Grubb, Robert L., III ;
Buys, Saundra S. ;
Chia, David ;
Church, Timothy R. ;
Fouad, Mona N. ;
Gelmann, Edward P. ;
Kvale, Paul A. ;
Reding, Douglas J. ;
Weissfeld, Joel L. ;
Yokochi, Lance A. ;
Crawford, E. David ;
O'Brien, Barbara ;
Clapp, Jonathan D. ;
Rathmell, Joshua M. ;
Riley, Thomas L. ;
Hayes, Richard B. ;
Kramer, Barnett S. ;
Izmirlian, Grant ;
Miller, Anthony B. ;
Pinsky, Paul F. ;
Prorok, Philip C. ;
Gohagan, John K. ;
Berg, Christine D. .
NEW ENGLAND JOURNAL OF MEDICINE, 2009, 360 (13) :1310-1319
[2]   Explaining the decrease in mortality from abdominal aortic aneurysm rupture [J].
Anjum, A. ;
von Allmen, R. ;
Greenhalgh, R. ;
Powell, J. T. .
BRITISH JOURNAL OF SURGERY, 2012, 99 (05) :637-645
[3]   Is the Incidence of Abdominal Aortic Aneurysm Declining in the 21st Century? Mortality and Hospital Admissions for England & Wales and Scotland [J].
Anjum, A. ;
Powell, J. T. .
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2012, 43 (02) :161-166
[4]  
[Anonymous], 2011, NHS ABD AORT AN SCRE
[5]  
[Anonymous], 2013, GUID METH TECHN APPR
[6]  
[Anonymous], HUM MORT DAT
[7]  
Ashton H, 2001, J MED SCREEN, V8, P46
[8]  
Ashton HA, 2007, BRIT J SURG, V94, P696, DOI 10.1002/bjs.5780
[9]   The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial [J].
Ashton, HA ;
Buxton, MJ ;
Day, NE ;
Kim, LG ;
Marteau, TM ;
Scott, RAP ;
Thomspon, SG ;
Walker, NM .
LANCET, 2002, 360 (9345) :1531-1539
[10]   Once-only flexible sigmoidoscopy screening in prevention of colorectal cancer: a multicentre randomised controlled trial [J].
Atkin, Wendy S. ;
Edwards, Rob ;
Kralj-Hans, Ines ;
Wooldrage, Kate ;
Hart, Andrew R. ;
Northover, John M. A. ;
Parkin, D. Max ;
Wardle, Jane ;
Duffy, Stephen W. ;
Cuzick, Jack .
LANCET, 2010, 375 (9726) :1624-1633