Cost-effectiveness of targeted screening for abdominal aortic aneurysm in siblings

Hultgren, Rebecka; Linné, Anneli; Svensjö, Sverker

doi:10.1002/bjs.11047

Cited by 9 publications

(7 citation statements)

References 53 publications

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“…Contemporary analysis on population-based screening in men confirms the cost effectiveness, and reduction in AAA-related and all-cause mortality, which is not shown in women [45]. It is however cost effective to invite targeted risk groups, such as first-degree relatives, which would also include women at high risk [46]…”

Section: Discussionmentioning

confidence: 99%

A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease

et al. 2019

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Objective In a population-based cohort of ruptured abdominal aortic aneurysms (rAAAs), our aim was to investigate clinical, morphological and biomechanical features in patients with small rAAAs. Methods All patients admitted to an emergency department in Stockholm and Gotland, a region with a population of 2.1 million, between 2009–2013 with a CT-verified rupture (n = 192) were included, and morphological measurements were performed. Patients with small rAAAs, maximal diameter (Dmax) ≤ 60 mm were selected (n = 27), and matched 2:1 by Dmax, sex and age to intact AAA (iAAAs). For these patients, morphology including volume and finite element analysis-derived biomechanics were assessed. Results The mean Dmax for all rAAAs was 80.8 mm (SD = 18.9 mm), women had smaller Dmax at rupture (73.4 ± 18.4 mm vs 83.1 ± 18.5 mm, p = 0.003), and smaller neck and iliac diameters compared to men. Aortic size index (ASI) was similar between men and women (4.1 ± 3.1 cm/m 2 vs 3.8 ± 1.0 cm/m 2 ). Fourteen percent of all patients ruptured at Dmax ≤ 60 mm, and a higher proportion of women compared to men ruptured at Dmax ≤ 60 mm: 27% (12/45) vs. 10% (15/147), p = 0.005. Also, a higher proportion of patients with a chronic obstructive pulmonary disease ruptured at Dmax ≤ 60 mm (34.6% vs 14.6%, p = 0.026). Supra-renal aortic size index (14.0, IQR 13.3–15.3 vs 12.8, IQR = 11.4–14.0) and peak wall rupture index (PWRI, 0.35 ± 0.08 vs 0.43 ± 0.11, p = 0.016) were higher for small rAAAs compared to matched iAAAs. Aortic size index, peak wall stress and aneurysm volume did not differ. Conclusion More than one tenth of ruptures occur at smaller diameters, women continuously suffer an even higher risk of presenting with smaller diameters, and this must be considered in surveillance programs. The increased supra-renal aortic size index and PWRI are potential markers for rupture risk, and patients under surveillance with these markers may benefit from increased attention, and potentially from timely repair.

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Section: Discussionmentioning

confidence: 99%

A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease

et al. 2019

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“…The model is derived from a previously validated and published AAA screening model, modified to suit the context of assessing FDR screening. The model was developed in the TreeAge Pro 2017 Healthcare software package (TreeAge Software, Williamstown, MA, USA) [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

“…It is not known if this is similar for adult offspring, but basic knowledge of hereditary traits in other disease groups suggests that it would be [ 13 , 14 ]. Although the prevalence is higher and the cost-efficiency of screening siblings now is estimated to be at least similar to screening of 65-year-old men, no systematic attempt to screen or detect AAA is performed for this high-risk group [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluating feasibility of using national registries for identification, invitation, and ultrasound examination of persons with hereditary risk for aneurysm disease—detecting abdominal aortic aneurysms in first degree relatives (adult offspring) to AAA patients (DAAAD)

Hultgren

Fattahi

Nilsson

et al. 2022

Pilot Feasibility Stud

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Background Sweden and the UK invite all 65-year-old men to a population-based ultrasound-based screening program to detect abdominal aortic aneurysms (AAA). First-degree relatives of patients with AAA are reported to have an increased risk to develop AAA, both women and men, but are not invited to screening. The “Detecting AAA in First Degree Relatives to AAA patients” (DAAAD) was designed to detect the true prevalence in adult offspring to AAA patients and to evaluate if national registries could be used for identification of index persons and their adult children with a high risk for the disease. The aim of this study is to summarize the design and methodology for this registry-based study. Methods The study is based on a registry-based extraction and identification of a risk group in the population with a subsequent identification of their adult offspring. The targeted risk group suffers a heredity for a potentially lethal disease, AAA (n = 750) and matched control group without heredity for AAA is also identified and invited (n = 750). The participation rate in the population-based AAA screening program for men is 75% regionally. This population is younger and have a lower prevalence. A participation rate of 65% is considered clinically adequate. For the DAAAD study, a stratified analysis of the primary outcome, prevalence, will be performed for women and men separately. Two other planned projects are based on the material: firstly, evaluation of the anxiety for disease and health-related quality of life (HRQoL) and, secondly, the cost-effectiveness of the study. Discussion In conclusion, this feasibility study will be instrumental in supporting the development of a possible new model to invite persons with high risk to develop hereditary rare diseases. To our knowledge, this is a unique, safe, and most likely to be a cost-efficient model to invite targeted risk groups for selected screening. If the study design and the results are shown to be cost-effective at the detected participation rate and prevalence, it should be further evaluated and adopted to a national screening program. The model also invites both women and men, which is unique for this specific patient group, considering that all population-based screening programs only include men. Trial registration This trial is registered at the website of Clinical Trials. ClinicalTrials.gov identifier, NCT4623268

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“…This screening can give the following absolute risk reduction: 6 prevented death/1000 invited versus 1 to 2 in 65-year-old men. 8…”

Section: Abdominal Aortic Aneurysmmentioning

confidence: 99%

Summary of the Symposium of Sex and Gender in Physiology and Pharmacology Held at the Royal Swedish Academy of Sciences in Stockholm, October 2018

2019

Gender and the Genome

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The process of creating the content of the knowledge bank is presented in Figure 1 and can be summarized as follows: (1) standard literature searches are performed according to a template and the collected knowledge is summarized in a text document for each substance; (2) different information sources are used, such as scientific articles, product labels, and clinical textbooks; (3) each document is discussed in a panel with clinical experts and is also assigned to a classification based on the available evidence; (4) information is collected in a database and linked to national registers of pharmaceutical substances and products approved in Sweden; (5) the information is presented on the website Janusinfo (note 1), provided by the regional Drug and Therapeutic Committee in Stockholm. There are also plans to integrate the knowledge base to electronic health record systems. Prioritized are medications recommended by the regional drug and therapeutic committee and medications commonly used in Sweden.

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Cost-effectiveness of targeted screening for abdominal aortic aneurysm in siblings

Cited by 9 publications

References 53 publications

A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease

A large proportion of patients with small ruptured abdominal aortic aneurysms are women and have chronic obstructive pulmonary disease

Evaluating feasibility of using national registries for identification, invitation, and ultrasound examination of persons with hereditary risk for aneurysm disease—detecting abdominal aortic aneurysms in first degree relatives (adult offspring) to AAA patients (DAAAD)

Summary of the Symposium of Sex and Gender in Physiology and Pharmacology Held at the Royal Swedish Academy of Sciences in Stockholm, October 2018

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