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Health gains, costs and cost‐effectiveness of a population‐based screening programme for abdominal aortic aneurysms. BJS 2019; 106: 1043-1054.

Published: 22nd May 2019

Authors: N. Nair, G. Kvizhinadze, G. T. Jones, R. Rush, M. Khashram, J. Roake et al.

Background

Abdominal aortic aneurysm (AAA) rupture carries a high fatality rate. AAAs can be detected before rupture by abdominal ultrasound imaging, allowing elective repair. Population‐based screening for AAA in older men reduces AAA‐related mortality by about 40 per cent. The UK began an AAA screening programme offering one‐off scans to men aged 65 years in 2009. Sweden has a similar programme. Currently, there is no AAA screening programme in New Zealand. This cost–utility analysis aimed to assess the cost‐effectiveness of a UK‐style screening programme in the New Zealand setting.

Method

The analysis compared a formal AAA screening programme (one‐off abdominal ultrasound imaging for about 20 000 men aged 65 years in 2011) with no systematic screening. A Markov macrosimulation model was adapted to estimate the health gains (in quality‐adjusted life‐years, QALYs), health system costs and cost‐effectiveness in New Zealand. A health system perspective and lifetime horizon was adopted.

Results

With New Zealand‐specific inputs, the adapted model produced an estimate of about NZ $15 300 (€7746) per QALY gained, with a 95 per cent uncertainty interval (UI) of NZ $8700 to 31 000 (€4405 to 15 694) per QALY gained. Health gains were estimated at 117 (95 per cent UI 53 to 212) QALYs. Health system costs were NZ $1·68 million (€850 535), with a 95 per cent UI of NZ $820 200 to 3·24 million (€415 243 to €1·65 million).

Conclusion

Using New Zealand's gross domestic product per capita (about NZ $45 000 or €22 100) as a cost‐effectiveness threshold, a UK‐style AAA screening programme would be cost‐effective in New Zealand.

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1 Comment

ANTONIO STERPETTI

1 month ago

I read with much interest the paper by Nair et al. about the importance of screening for AAA.

They refer to the UK screening program which includes patients aged 65 years or more.
In recent epidmiological studies, the number of patients with AAA aged less than 65 years is increasing. Probably this observation comes from an improved diagnostic test, but in autoptic studies, we confirmed the epidemiological evidence that the prevalence of AAA is increasing, even in patients younger than 65 years of age. Probably, screening should be performed at an earlier age.

Nowadays, abdominal ultrasound is frequently performed and the majority of the population has at least one ultrasound examination before the age of 50 years.

Screening for AAA is important, but probably it is more useful to look at the abdominal aorta in all patients undergoing abdominal and cardiac ultrasound.

It seems obvious, but practice teaches that the risk factor represented by minor enlargement or smaller aneurysms on abdominal ultrasound are often overlooked . Not rarely, the examiner excludes the abdominal aorta from the investigation, namely in cardiac evaluations.

A Sterpetti
antonio.sterpetti@uniroma1.it

References:
1. Sterpetti AV, Cavallaro A, Cavallari N, Allegrucci P, Tamburelli A, Agosta F, Bartoli S. Factors influencing the rupture of abdominal aortic aneurysms. Surg Gynecol Obstet 1991; 173(3): 175-8.
2. Sterpetti AV, Schultz RD, Feldhaus RJ, Peetz DJ Jr, Fasciano AJ, McGill JE. Abdominal aortic aneurysm in elderly patients. Selective management based on clinical status and aneurysmal expansion rate. Am J Surg 1985; 150(6): 772-776.