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Cost‐effectiveness of population‐based vascular disease screening and intervention in men from the Viborg Vascular (VIVA) trial. BJS 2018; 105: 1283-1293.

Published: 25th April 2018

Authors: R. Søgaard, J. S. Lindholt

Background

Population‐based screening and intervention for abdominal aortic aneurysm, peripheral artery disease and hypertension was recently reported to reduce the relative risk of mortality among Danish men by 7 per cent. The aim of this study was to investigate the cost‐effectiveness of vascular screening versus usual care (ad hoc primary care‐based risk assessment) from a national health service perspective.

Method

A cost‐effectiveness evaluation was conducted alongside an RCT involving all men from a region in Denmark (50 156) who were allocated to screening (25 078) or no screening (25 078) and followed for up to 5 years. Mobile nurse teams provided screening locally and, for individuals with positive test results, referrals were made to general practices or hospital‐based specialized centres for vascular surgery. Intention‐to‐treat‐based, censoring‐adjusted incremental costs (2014 euros), life‐years and quality‐adjusted life‐years (QALYs) were estimated using Lin's average estimator method. Incremental net benefit was estimated using Willan's estimator and sensitivity analyses were conducted.

Results

The cost of screening was estimated at €148 (95 per cent c.i. 126 to 169), and the effectiveness at 0·022 (95 per cent c.i. 0·006 to 0·038) life‐years and 0·069 (0·054 to 0·083) QALYs, generating average costs of €6872 per life‐year and €2148 per QALY. At a willingness‐to‐pay threshold of €40 000 per QALY, the probabilities of cost‐effectiveness were 98 and 99 per cent respectively. The probability of cost‐effectiveness was 71 per cent when all the sensitivity analyses were combined into one conservative scenario.

Conclusion

Vascular screening appears to be cost‐effective and compares favourably with current screening programmes.

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