Long-term benefit and cost-effectiveness analysis of screening for abdominal aortic aneurysms from a randomized controlled trial

Abstract

The mortality benefit of screening for AAA in men aged 64-73 years was maintained in the longer term and screening was cost effective.

Systematic review and meta-analysis of the growth and rupture rates of small abdominal aortic aneurysms: implications for surveillance intervals and their cost-effectiveness

“…57 Since that review, a number of further modelling studies have been published drawing on data from a variety of sources: for example studies relating to Italy, 15 to the Netherlands and Norway, 58 to Canada 59,60 and to Denmark. 61 These have all concluded that screening is acceptably cost-effective, with the exception of a study using data from Denmark and other sources, which concluded that screening did not seem to be cost-effective. 62 A recent modelling study, again using Danish data, contradicts that previous conclusion, suggesting that screening men at age 65 years is highly cost-effective compared with no screening and, additionally, that rescreening after 5 years may be a cost-effective extension to the programme.…”

The Evidence for Management of Abdominal Aortic Aneurysms: Lessons Learned from Randomised Controlled Trials

“…This has led to the concept of its use for screening of at risk populations. In the last 20 years there have been four population based randomised controlled trials which have assessed the value of targeted screening in reducing mortality from abdominal aortic aneurysms in the unselected elderly male population [2][3][4][5] . These trials which have been undertaken in Chichester (England) 2 , England (MASS trial) 3 , Viborg County (Denmark) 4 and the city of Perth and suburbs (Western Australia) 5 have together recruited over 120,000 subjects.…”

Population based ultrasonographic screening of abdominal aortic aneurysms

“…AAA-related mortality has been shown to decrease by 40 % at 3-5 years [11], and 42-66 % at 13 years [12,13], with an absolute decline in mortality by 1.4 per 1000 men [12]. AAA-mortality at 5-12 years was shown to be 0-2.4 % [5,6], with a 42-52 % decrease of AAA related death in those who attended screening [12,13].…”

“…All-cause mortality was also shown to be slightly decreased by 3 % at 11-15 years, possibly due to management of other cardiovascular risk factors [1,12]. The incidence of rupture was also significantly reduced (Hazard ratio of 0.44-0.57) up to 13 years [12,13]. The rate of emergency repair was halved and elective repair doubled upto 13-15 years [12,13].…”

“…The incidence of rupture was also significantly reduced (Hazard ratio of 0.44-0.57) up to 13 years [12,13]. The rate of emergency repair was halved and elective repair doubled upto 13-15 years [12,13]. This robust data led the United States Preventive Services Task Force (USPSTF) to recommend a one-time US AAA screening in male smokers of age 65-75 years.…”