Screening men for abdominal aortic aneurysm saves lives, but is it cost-effective?


NEW YORK (Reuters Health), Jun 26 - The results of a U.K. study suggest that screening older men for abdominal aortic aneurysm (AAA) provides a durable survival benefit and becomes cost-effective over time. However, in a Danish study, screening for AAA in older men did not seem to be cost-effective.

The results of both studies are reported in the June 26 Online First issue of BMJ.

Dr. S. G. Thompson, from the Institute of Public Health, Cambridge, and colleagues assessed mortality and AAA-related costs in 67,770 U.K. men, 65 to 74 years of age, who were randomized to receive or not receive an invitation for ultrasound-based AAA screening. Subjects found to have an AAA underwent surveillance and were offered surgery if standard operative criteria were met.

During 10 years of follow-up, 155 men in the screening group died from AAA, compared with 296 men in control group, which corresponds to rates of 0.46% and 0.87%. Thus, screening reduced the relative risk of AAA-related death by 48%. The survival benefit with screening was apparent early on and was maintained throughout the study period.

The incremental cost-effectiveness ratio per life year gained was 7,600 pounds, the report indicates.

In the second study, Dr. Lars Ehlers, from Aarhus University, Denmark, and co-researchers used an economic decision model to assess the cost-effectiveness of ultrasound-based AAA screening in Danish men age 65.

The authors calculate that with a willingness-to-pay threshold of 30,000 pounds, the likelihood of AAA screening being cost-effective was less than 30%. The incremental cost-effectiveness ratio per quality-adjusted life year was between 32,640 and 66,001 pounds.

So why was AAA screening cost-effective in the U.K. study, but not in the Danish one? The reasons are not entirely clear, but in an accompanying editorial, Dr. Martin Buxton, from Brunel University, Uxbridge, U.K., offers a possible explanation.

"Ehlers and colleagues used estimates of Danish costs that differed in important ways from the estimates in (the U.K. screening study) -- the costs of screening are higher in Denmark compared with the U.K. and the differential cost between elective and emergency surgery is substantially lower. Both these factors would make screening seem less cost-effective."

BMJ 2009.

Last Updated: 2009-06-25 19:01:13 -0400 (Reuters Health)

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