Abdominal aortic aneurysm screening: how many life years lost from underuse of the medicare screening benefit?

Abstract

Background: Since 2007, Medicare has provided one-time abdominal aortic aneurysm (AAA) screening for men with smoking history, and men and women with a family history of AAA as part of its Welcome to Medicare visit.

Objective: We examined utilization of the new AAA screening benefit and estimated how increased utilization could influence population health as measured by life years gained. Additionally, we explored the impact of expanding screening to women with smoking history.

Design: Analysis of Medicare claims and a simulation model to estimate the effects of screening, using published data for parameter estimates.

Setting: AAA screening in the primary care setting.

Patients: Newly-enrolled Medicare beneficiaries aged 65 years, with smoking history or family history of AAA.

Main measures: Life expectancy, 10-year survival rates.

Key results: Medicare data revealed low utilization of AAA screening, under 1% among those eligible. We estimate that screening could increase life expectancy per individual invited to screening for men with smoking history (0.11 years), with family history of AAA (0.17 years), and women with family history (0.08 years), and smoking history (0.09 years). Average gains of 131 life years per 1,000 persons screened for AAA compare favorably with the grade B United States Preventive Services Task Force (USPSTF) recommendation for breast cancer screening, which yields 95-128 life years per 1,000 women screened. These findings were robust over a range of scenarios.

Limitations: The simulation results reflect assumptions regarding AAA prevalence, treatment, and outcomes in specific populations based on published research and US survey data. Published data on women were limited.

Conclusions: 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.

Figure 1

Simulation model structure (annual iteration per simulated individual).

Figure 2

Cumulative life years gained from the use of Medicare AAA screening benefit, compared with current use levels.