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Comparative Study
. 2012 Jul 5:345:e4276.
doi: 10.1136/bmj.e4276.

Cost effectiveness of abdominal aortic aneurysm screening and rescreening in men in a modern context: evaluation of a hypothetical cohort using a decision analytical model

Rikke Søgaard  1 , Jesper Laustsen, Jes S Lindholt
Affiliations
Comparative Study

Cost effectiveness of abdominal aortic aneurysm screening and rescreening in men in a modern context: evaluation of a hypothetical cohort using a decision analytical model

Rikke Søgaard et al. BMJ. .

Abstract

Objective: To assess the cost effectiveness of different screening strategies for abdominal aortic aneurysm in men, from the perspective of a national health service.

Setting: Screening units at regional hospitals.

Participants: Hypothetical cohort of 65 year old men from the general population.

Main outcome measures: Costs (£ in 2010) and effect on health outcomes (quality adjusted life years (QALYs)).

Results: Screening seems to be highly cost effective compared with not screening. The model estimated a 92% probability that some form of screening would be cost effective at a threshold of £20,000 (€24,790; $31,460). If men with an aortic diameter of 25-29 mm at the initial screening were rescreened once after five years, 452 men per 100,000 initially screened would benefit from early detection, whereas lifetime rescreening every five years would detect 794 men per 100,000. We estimated the associated incremental cost effectiveness ratios for rescreening once and lifetime rescreening to be £10,013 and £29,680 per QALY, respectively. The individual probability of being the most cost effective strategy was higher for each rescreening strategy than for the screening once strategy (in view of the £20,000 threshold).

Conclusions: This study confirms the cost effectiveness of screening versus no screening and lends further support to considerations of rescreening men at least once for abdominal aortic aneurysm.

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Conflict of interest statement

All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: support from the Health Research Fund of Central Denmark Region and the Research Fund of Viborg Hospital; JSL was sponsored by the 7th European Framework Programme (Health-2007-2.4.2-2; project title “Fighting aneurysmal disease”; grant agreement no 200647); no other relationships or activities that could appear to have influenced the submitted work.

Figures

None
Fig 1 Markov model for the course of abdominal aortic aneurysms. Diagram is a simplified presentation of the disease history and relevant modalities for intervention. Eight boxes to the left of the diagram=starting states; numbers=abdominal aortic diameter (mm). Men either remain in their current state or move to a neighbouring state, following the connecting lines. Detection of aneurysms can be incidental or follow on from systematic screening
See this image and copyright information in PMC

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