Abdominal Aortic Aneurysm Screening: How Many Life Years Lost from Underuse of the Medicare Screening Benefit?

Abstract

The Welcome to Medicare and AAA screening benefits have been underutilized. Increasing utilization of AAA screening would yield substantial gains in life expectancy. Expanding screening to women with smoking history also has the potential for substantial health benefits.

Screening Older Adult Men for Abdominal Aortic Aneurysm: A Scoping Review

“…To empirically inform updated guidelines, new trials studying the outcomes of screening older men for AAA within the current epidemiological climate should be completed. Since findings in the current review demonstrate a decline in AAA prevalence in men, guidelines should reflect the need for PCPs to evaluate older men individually for AAA screening appropriateness, by taking personal risk factors and estimated life expectancy into account ( Olchanski et al, 2014 ). For instance, men with a higher number of comorbid conditions, such as acquired immunodeficiency syndrome (AIDS), dementia, liver disease, renal failure, heart failure, and chronic obstructive pulmonary disease (COPD), have shorter life spans ( Cho et al, 2013 ).…”

“…For instance, although improved survival and decreased mortality as a result of screening is indisputable, the tendency in the United States and Australia to repair AAAs smaller than the recommended threshold may threaten benefits and cost-effectiveness ( Lederle, 2016 ). Implementing a widespread AAA screening policy that is patient centered, focused on mortality benefits, and feasible for PCP workflow should be considered by policymakers as it has been proven to be highly cost effective in several European countries ( Olchanski et al, 2014 ; Pettersson et al, 2017 ; Spronk et al, 2011 ). As a result of widely accepted AAA screening policies and programs, practicing routine AAA screening for older men may become normalized and the benefits of screening, as shown in the current review, might come to fruition.…”

“…Despite guidelines, participation in screening among men remains low in the United States. For instance, Olchanski et al (2014) reported that less than 1% of eligible men were screened for AAA. To date, there are no provincial or federal AAA screening programs for men in Canada ( Ali et al, 2016 ).…”

Abdominal aortic aneurysm screening program using hand-held ultrasound in primary healthcare

“…Recently, a systematic review of four population-based screening trials [ 19 – 22 ] by the U.S. Preventive Services Task Force concluded that screening of men aged ≥ 65 years reduced AAA-related mortality rates by 50% over 13–15 years [ 23 ]. Medicare data showed the utilization of AAA screening in the USA was under 1% in eligible patients [ 24 ]. However, in Spain, the health system is universal, public and free-at-the-point-of-use.…”

Capsule Commentary on Olchanski et al., Abdominal Aortic Aneurysm Screening: How Many Life Years Lost from Underuse of the Medicare Screening Benefit?

“…T his study by Olchanski et al 1 investigated utilization of the abdominal aortic aneurysm (AAA) screening benefit through the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act for Medicare beneficiaries, and estimated whether increasing its utilization would increase life expectancy. The authors conclude that screening benefits have been underutilized (< 1 % each year among those newly eligible) and that increasing utilization to 80 % of the eligible population would yield substantial gains in life expectancy.…”