Published 24 June 2009, doi:10.1136/bmj.b2243
Cite this as: BMJ 2009;338:b2243

Research

Analysis of cost effectiveness of screening Danish men aged 65 for abdominal aortic aneurysm

¹ Institute of Public Health, Aarhus University, Vennelyst Boulevard 6, 8000 Aarhus C, Denmark, ² Department of Cardiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark, ³ Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, Denmark, ⁴ Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark, ⁵ Health Technology Assessment and Health Services Research, Centre for Public Health, Central Region, Denmark

Objective To assess the cost effectiveness of screening men aged 65 for abdominal aortic aneurysm.

Design Cost effectiveness analysis based on a probabilistic, enhanced economic decision analytical model from screening to death.

Population and setting Hypothetical population of men aged 65 invited (or not invited) for ultrasound screening in the Danish healthcare system.

Data sources Published results from randomised trials and observational epidemiological studies retrieved from electronic bibliographic databases, and supplementary data obtained from the Danish Vascular Registry.

Data synthesis A hybrid decision tree and Markov model was developed to simulate the short term and long term effects of screening for abdominal aortic aneurysm compared with no systematic screening on clinical and cost effectiveness outcomes. Probabilistic sensitivity analyses using Monte Carlo simulation were carried out. Results were presented in a cost effectiveness acceptability curve, an expected value of perfect information curve, and a curve showing the expected (net) number of avoided deaths from abdominal aortic aneurysm over time after the introduction of screening. The model was validated by calibrating base case health outcomes and expected activity levels against evidence from the recent Cochrane review of screening for abdominal aortic aneurysm.

Results The estimated costs per quality adjusted life year (QALY) gained discounted at 3% per year over a lifetime for costs and QALYs was £43 485 (54 852; $71 160). At a willingness to pay threshold of £30 000 the probability of screening for abdominal aortic aneurysm being cost effective was less than 30%. One way sensitivity analyses showed the incremental cost effectiveness ratio varying from £32 640 to £66 001 per QALY.

Conclusion Screening for abdominal aortic aneurysm does not seem to be cost effective. Further research is needed on long term quality of life outcomes and costs.

© Ehlers et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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