Cost effectiveness of abdominal aortic aneurysm screening and rescreening in men in a modern context: evaluation of a hypothetical cohort using a decision analytical modelBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e4276 (Published 05 July 2012) Cite this as: BMJ 2012;345:e4276
- Rikke Søgaard, associate professor1,
- Jesper Laustsen, chief vascular surgeon2,
- Jes S Lindholt, professor34
- 1Centre for Applied Health Services Research and Technology Assessment (CAST), Institute for Public Health, University of Southern Denmark, 5000 Odense, Denmark
- 2Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
- 3Vascular Research Unit, Viborg Hospital, Viborg, Denmark
- 4Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Correspondence to: R Søgaard
- Accepted 21 May 2012
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.
We thank the key stakeholders and field experts who were invited to observe the development of the model (Anders Green, Ole Andersen, Henrik Sillesen, and Jan Sørensen), who provided meaningful contributions at different stages of the project; the Danish society for vascular surgery, which provided ad hoc estimates from the Danish vascular registry.
Contributors: JSL and RS conceived the study. The model was specified in close collaboration between RS (health economist who specified the methodology, built the model, and defined the parameters) and JSL and JL (clinical experts who guided the definition of strategies and conducted literature searches or original analysis of primary data). RS conducted the analysis, drafted the manuscript, and is responsible for the overall content as guarantor. JSL and JL participated in a critical revision of the manuscript, and all authors approved the final version.
Funding: The Health Research Fund of Central Denmark Region and the Research Fund of Viborg Hospital funded the work. The sponsors had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
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.
Ethical approval: No ethical approval was required. The study was approved by the Danish Data Protection Agency.
Data sharing: No additional data are available (the model builds on secondary data).
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