Published 28 July 2009, doi:10.1136/bmj.b3044
Cite this as: BMJ 2009;339:b3044

Letters

Abdominal aortic aneurysm

Comparing studies for cost effectiveness of screening

The first 150 words of the full text of this article appear below.

Ehlers and colleagues conclude from their long term modelling study that screening men aged 65 for abdominal aortic aneurysm is not cost effective.¹ This conclusion conflicts with that of the 10 year follow-up of the randomised Multicentre Aneurysm Screening Study (MASS),² our detailed long term modelling based on individual patient data in MASS,^{3 4} and other recent modelling studies.

To try to understand the reasons for the difference, we substituted the unit costs and parameter estimates provided by Ehlers into our model based on MASS. Although the cost per quality adjusted life year (QALY) increased from our original estimate of £3000 to around £6000, it does not begin to approach their figure of £43 000. So there must be other explanations, such as the structure or assumptions of their model, which cannot be investigated without further information from the authors.⁵

Their cost effectiveness estimate is implausible. From observed data in MASS, . . . [Full text of this article]

¹ MRC Biostatistics Unit, Institute of Public Health, Cambridge CB2 0SR, ² London School of Hygiene and Tropical Medicine, London WC1E 7HT

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