Impact of the first 5 years of a national abdominal aortic aneurysm screening programme

Jacomelli, Jo; Summers, Lisa; Stevenson, Anne; Lees, Tim; Earnshaw, J. J.

doi:10.1002/bjs.10173

Cited by 135 publications

(69 citation statements)

References 27 publications

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“…Based on the observed ratio of men to women (52 per cent women and 48 per cent men) among siblings identified for targeted screening 10 , the cohorts were simulated as a single cohort consisting of both men and women, with proportionately weighted data on mortality and disease prevalence. Attendance (86 per cent) after invitation to screening for siblings 28 was similar to that for men invited to the MASS (80 per cent) 25 , as well as the reported contemporary attendance in the Swedish AAA Screening Programme (84 per cent) 3 and the National Health Service AAA Screening Programme (NAAASP) in England (78 per cent) 1 .…”

Section: Model Assumptionssupporting

confidence: 53%

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

Hultgren

Linné

Svensjö

2019

British Journal of Surgery

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Background Population screening for abdominal aortic aneurysm (AAA) in 65‐year‐old men has been shown to be cost‐effective. A risk group with higher prevalence is siblings of patients with an AAA. This health economic model‐based study evaluated the potential cost‐effectiveness of targeted AAA screening of siblings. Methods A Markov model validated against other screening programmes was used. Two methods of identifying siblings were analysed: direct questioning of patients with an AAA (method A), and employing a national multigeneration register (method B). The prevalence was based on observed ultrasound data on AAAs in siblings. Additional parameters were extracted from RCTs, vascular registers, literature and ongoing screening. The outcome was cost‐effectiveness, probability of cost‐effectiveness at different willingness‐to‐pay (WTP) thresholds, reduction in AAA death, quality‐adjusted life‐years (QALYs) gained and total costs on a national scale. Results Methods A and B were estimated to reduce mortality from AAA, at incremental cost‐effectiveness ratios of €7800 (95 per cent c.i. 4627 to 12 982) and €7666 (5000 to 13 373) per QALY respectively. The probability of cost‐effectiveness was 99 per cent at a WTP of €23 000. The absolute risk reduction in AAA deaths was five per 1000 invited. QALYs gained were 27 per 1000 invited. In a population of ten million, methods A and B were estimated to prevent 12 and 17 AAA deaths, among 2418 and 3572 siblings identified annually, at total costs of €499 500 and €728 700 respectively. Conclusion The analysis indicates that aneurysm‐related mortality could be decreased cost‐effectively by applying a targeted screening method for siblings of patients with an AAA.

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Section: Model Assumptionssupporting

confidence: 53%

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

Hultgren

Linné

Svensjö

2019

British Journal of Surgery

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“…It is drummed into rural Australians that they are responsible for their health, so many may have had previous investigations where their AAA will have been diagnosed already. This seems different from the UK and Swedish populations, 5,6 where the background level of investigation appears lower and the rate of undetected disease higher. Screening programs have more to offer populations such as these.…”

contrasting

confidence: 63%

Final Say on Research Into Population Screening for Abdominal Aortic Aneurysm

Earnshaw

2017

Angiology

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“…3·96 to 31·99; P < 0·001). Similarly, Ulug and co‐workers36 demonstrated that turn‐down rates were higher in women than men (34 versus 19 per cent; OR 2·27, 1·21 to 4·23), compared with 9·2 per cent within the first 5 years of the NHS Abdominal Aortic Aneurysm Screening Programme (men only)37.…”

Section: Discussionmentioning

confidence: 95%

Sex differences in mortality after abdominal aortic aneurysm repair in the UK

Sidloff

Saratzis

Sweeting

et al. 2017

British Journal of Surgery

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BackgroundThe UK abdominal aortic aneurysm (AAA) screening programmes currently invite only men for screening because the benefit in women is uncertain. Perioperative risk is critical in determining the effectiveness of screening, and contemporary estimates of these risks in women are lacking. The aim of this study was to compare mortality following AAA repair between women and men in the UK.MethodsAnonymized data from the UK National Vascular Registry (NVR) for patients undergoing AAA repair (January 2010 to December 2014) were analysed. Co‐variables were extracted for analysis by sex. The primary outcome measure was in‐hospital mortality. Secondary outcome measures included mortality by 5‐year age groups and duration of hospital stay. Logistic regression was performed to adjust for age, calendar time, AAA diameter and smoking status. NVR‐based outcomes were checked against Hospital Episode Statistics (HES) data.ResultsA total of 23 245 patients were included (13·0 per cent women). Proportionally, more women than men underwent open repair. For elective open AAA repair, the in‐hospital mortality rate was 6·9 per cent in women and 4·0 per cent in men (odds ratio (OR) 1·48, 95 per cent c.i. 1·08 to 2·02; P = 0·014), whereas for elective endovascular AAA repair it was 1·8 per cent in women and 0·7 per cent in men (OR 2·86, 1·72 to 4·74; P < 0·001); the results in HES were similar. For ruptured AAA, there was no sex difference in mortality within the NVR; however, in HES, for ruptured open AAA repair, the in‐hospital mortality rate was higher in women (33·6 versus 27·1 per cent; OR 1·36, 1·16 to 1·59; P < 0·001).ConclusionWomen have a higher in‐hospital mortality rate than men after elective AAA repair even after adjustment. This higher mortality may have an impact on the benefit offered by any screening programme offered to women.

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Impact of the first 5 years of a national abdominal aortic aneurysm screening programme

Abstract: The processes in the NHS AAA Screening Programme are effective in detecting and treating men with AAA.

Cited by 135 publications

References 27 publications

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

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

Final Say on Research Into Population Screening for Abdominal Aortic Aneurysm

Sex differences in mortality after abdominal aortic aneurysm repair in the UK

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