RSS-Feed abonnieren
DOI: 10.1055/s-0029-1245140
© Georg Thieme Verlag KG Stuttgart · New York
Benefit, Risks and Cost-Effectiveness of Screening for Abdominal Aortic Aneurysm
Benefit, Risiken und Kosteneffizienz eines Screenings des abdominellen AortenaneurysmasPublikationsverlauf
received: 15.10.2009
accepted: 28.12.2009
Publikationsdatum:
18. Juni 2010 (online)
![](https://www.thieme-connect.de/media/roefo/201007/lookinside/thumbnails/10.1055-s-0029-1245140-1.jpg)
Zusammenfassung
Ziel: Das abdominelle Aortenaneurysma (AAA) ruft eine nicht unerhebliche Anzahl an Todesfällen hervor. Die Letalitätsrate bei rupturierten Aortenaneurysmen liegt bei 80 %. Die Absicht dieser Studie war es, die bestehende Evidenz der publizierten Gesundheitsmodelle hinsichtlich der Langzeitergebnisse und Kosteneffizienz von Screeningprogrammen für das AAA zusammenzufassen. Material und Methoden: Bis Oktober 2007 wurden medizinische, ökonomische und gesundheitspolitische Datensätze systematisch hinsichtlich kosteneffizienter Modelle herangezogen. Nur Modelle, welche Screeningprogramme für das AAA von Männern über 65 Jahren dokumentieren und einen lebenslangen Zeitraum modellieren, wurden in dieser Studie inkludiert. Die Daten dieser Modelle wurden extrahiert und in Evidenztabellen sowie grafischen Darstellungen bezüglich Kosteneffizienz zusammengefasst. Ergebnisse: Durchgesichtet wurden 8, zwischen 1993 und 2007 publizierte, kosteneffizienzbasierte Modelle, welche das Screening und das Nicht-Screening bezüglich des AAA bei Männern über 60 Jahren verglichen haben. Nur ein Modell hat einen Verlust an Lebensjahren in Kombination mit zusätzlichen Kosten beschrieben. Die restlichen 7 Modelle haben einen Gewinn an Lebensjahren zwischen 0,02 und 0,28 Lebensjahren dokumentiert. Ein Gewinn an qualitätsbezogener Lebenserwartung lag zwischen 0,015 und 0,059 QALYs in 6 von 7 Modellen. Die inkrementellen Kosten lagen zwischen 96 und 721 Euro. Das inkrementelle Kosten-Nutzen-Verhältnis lag zwischen 1443 und 13 299 € pro Lebensjahr oder gewonnen QALYs. Schlussfolgerung: Aufgrund unserer Analyse würde die Einführung eines Screeningprogramms für das AAA unter akzeptablen Mehrkosten einen Gewinn an Lebensjahren und -qualität bringen. Die Zielgruppe für das Screeningprogramm sollten Männer sein, die 65 Jahre oder älter sind.
Abstract
Purpose: Abdominal aortic aneurysms (AAA) cause a considerable number of deaths. A ruptured AAA is associated with a mortality rate of 80 %. The purpose of this study was to summarize the current evidence from published health economic models for the long-term effectiveness and cost-effectiveness of screening programs for AAA. Materials and Methods: Medical, economic and health technology assessment (HTA) databases were systematically searched for cost-effectiveness models up to October 2007. Only models with a lifetime time horizon of evaluating AAA screening in men over 65 years were included in the review. Study data were extracted, standardized and summarized in evidence tables and cost-effectiveness plots. Results: We reviewed 8 cost-effectiveness models published between 1993 and 2007 comparing AAA screening and lack of screening in men over 60. One model yielded a loss of life-years at additional costs. The remaining seven models yielded gains in life expectancy ranging from 0.02 to 0.28LYs. Gains in quality-adjusted life expectancy reported by six of the seven models ranged from 0.015 to 0.059 QALYs. Incremental costs ranged from 96 to 721 Euros. Incremental cost-effectiveness ratios (ICER) ranged from 1443 to 13 299 Euros per LY or QALY gained. Conclusion: Based on our analysis, the introduction of a screening program to identify AAA will probably gain additional life years and quality of life at acceptable extra costs. The target population for a screening program should be men 65 years and older.
Key words
aneurysm - abdomen - economics - ultrasound
References
- 1 Lindholt J S, Juul S, Henneberg E W. et al . Screening for abdominal aortic aneurysm. Ugeskr Laeger. 1997; 159 1915-1919
- 2 Lindholt J S, Fasting H, Henneberg E W. et al . Preliminary results of screening for abdominal aortic aneurysm in the ounty of Viborg. Ugeskr Laeger. 1997; 159 1920-1923
- 3 Brewster D C, Cronenwett J L, Hallett J W. et al . Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the Joint Council of the American Association for Vascular Surgery and Society for Vascular Surgery. J Vasc Surg. 2003; 37 1106-1117
- 4 Hirsch A T, Haskal Z J, Hertzer N R. et al . Guidelines for the Management of Patients with Peripheral Arterial Disease (lower extremity, renal, mesenteric, and abdominal aortic): a collaborative report from the American Associations for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease) – summary of recommendations. J Vasc Interv Radiol. 2006; 17 1383-1397, quiz 1398
- 5 Vardulaki K A, Prevost T C, Walker N M. et al . Incidence among men of asymptomatic abdominal aortic aneurysms: estimates from 500 screen detected cases. J Med Screen. 1999; 6 50-54
- 6 Singh Jr K, Bonaa K H, Jacobsen B K. et al . Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study: The Tromso Study. Am J Epidemiol. 2001; 154 236-244
- 7 Wilmink T B, Quick C R, Day N E. The association between cigarette smoking and abdominal aortic aneurysms. J Vasc Surg. 1999; 30 1099-1105
- 8 Lederle F A, Johnson G R, Wilson S E. et al . Prevalence and associations of abdominal aortic aneurysm detected through screening. Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group. Ann Intern Med. 1997; 126 441-449
- 9 Scott R A, Wilson N M, Ashton H A. et al . Influence of screening on the incidence of ruptured abdominal aortic aneurysm: 5-year results of a randomized controlled study. Br J Surg. 1995; 82 1066-1070
- 10 Ashton H A, Buxton M J, Day N E. et al . The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet. 2002; 360 1531-1539
- 11 Lindholt J S, Juul S, Fasting H. et al . Hospital costs and benefits of screening for abdominal aortic aneurysms. Results from a randomised population screening trial. Eur J Vasc Endovasc Surg. 2002; 23 55-60
- 12 Norman P E, Jamrozik K, Lawrence-Brown M M. et al . Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm. BMJ. 2004; 329 1259
- 13 Cosford P A, Leng G C. Screening for abdominal aortic aneurysm. Cochrane Database Syst Rev. 2007; CD002945
- 14 Lindholt J S, Juul S, Fasting H. et al . Cost-effectiveness analysis of screening for abdominal aortic aneurysms based on five year results from a randomised hospital based mass screening trial. Eur J Vasc Endovasc Surg. 2006; 32 9-15
- 15 Lindholt J S, Vammen S, Juul S. et al . The validity of ultrasonographic scanning as screening method for abdominal aortic aneurysm. Eur J Vasc Endovasc Surg. 1999; 17 472-475
- 16 LaRoy L L, Cormier P J, Matalon T A. et al . Imaging of abdominal aortic aneurysms. Am J Roentgenol. 1989; 152 785-792
- 17 Quill D S, Colgan M P, Sumner D S. Ultrasonic screening for the detection of abdominal aortic aneurysms. Surg Clin North Am. 1989; 69 713-720
- 18 Lederle F A. Ultrasonographic screening for abdominal aortic aneurysms. Ann Intern Med. 2003; 139 516-522
- 19 Bengtsson H, Norrgard O, Angquist K A. et al . Ultrasonographic screening of the abdominal aorta among siblings of patients with abdominal aortic aneurysms. Br J Surg. 1989; 76 589-591
- 20 Frame P S, Fryback D G, Patterson C. Screening for abdominal aortic aneurysm in men ages 60 to 80 years. A cost-effectiveness analysis. Ann Intern Med. 1993; 119 411-416
- 21 Law M R, Morris J, Wald N J. Screening for abdominal aortic aneurysms. J Med Screen. 1994; 1 110-115, discussion 115 – 116
- 22 Swedenborg J. Important to evaluate screening for abdominal aortic aneurysm in Sweden. Lakartidningen. 2003; 100 2001-2002
- 23 St L eger AS, Spencely M, McCollum C N. et al . Screening for abdominal aortic aneurysm: a computer assisted cost-utility analysis. Eur J Vasc Endovasc Surg. 1996; 11 183-190
- 24 Collin J, Araujo L, Walton J. A community detection program for abdominal aortic aneurysm. Angiology. 1990; 41 53-58
- 25 Lindholt J S. Screening for abdominal aortic aneurysm. Ugeskr Laeger. 2002; 164 157-159
- 26 Pentikainen T J, Sipila T, Rissanen P. et al . Cost-effectiveness of targeted screening for abdominal aortic aneurysm. Monte Carlo-based estimates. Int J Technol Assess Health Care. 2000; 16 22-34
- 27 Soisalon-Soininen S, Rissanen P, Pentikainen T. et al . Cost-effectiveness of screening for familial abdominal aortic aneurysms. Vasa. 2001; 30 262-270
- 28 Wanhainen A, Lundkvist J, Bergqvist D. et al . Cost-effectiveness of screening women for abdominal aortic aneurysm. J Vasc Surg. 2006; 43 908-914, discussion 914
- 29 Connelly J B, Hill G B, Millar W J. The detection and management of abdominal aortic aneurysm: a cost-effectiveness analysis. Clin Invest Med. 2002; 25 127-133
- 30 Russell J G. Is screening for abdominal aortic aneurysm worthwhile?. Clin Radiol. 1990; 41 182-184
- 31 Boll A P, Severens J L, Verbeek A L. et al . Mass screening on abdominal aortic aneurysm in men aged 60 to 65 years in The Netherlands. Impact on life expectancy and cost-effectiveness using a Markov model. Eur J Vasc Endovasc Surg. 2003; 26 74-80
- 32 Henriksson M, Lundgren F. Decision-analytical model with lifetime estimation of costs and health outcomes for one-time screening for abdominal aortic aneurysm in 65-year-old men. Br J Surg. 2005; 92 976-983
- 33 Henriksson M, Lundgren F, Carlsson P. Informing the efficient use of health care and health care research resources – the case of screening for abdominal aortic aneurysm in Sweden. Health Econ. 2006; 15 1311-1322
- 34 Kim L G, Thompson S G, Briggs A H. et al . How cost-effective is screening for abdominal aortic aneurysms?. J Med Screen. 2007; 14 46-52
- 35 Lee T Y, Korn P, Heller J A. et al . The cost-effectiveness of a ”quick-screen” program for abdominal aortic aneurysms. Surgery. 2002; 132 399-407
- 36 Mason J M, Wakeman A P, Drummond M F. et al . Population screening for abdominal aortic aneurysm: do the benefits outweigh the costs?. J Public Health Med. 1993; 15 154-160
- 37 Silverstein M D, Pitts S R, Chaikof E L. et al . Abdominal aortic aneurysm (AAA): cost-effectiveness of screening, surveillance of intermediate-sized AAA, and management of symptomatic AAA. Proc (Bayl Univ Med Cent). 2005; 18 345-367
- 38 Wanhainen A, Lundkvist J, Bergqvist D. et al . Cost-effectiveness of different screening strategies for abdominal aortic aneurysm. J Vasc Surg. 2005; 41 741-751, discussion 751
- 39 Kim L G, RA P S, Ashton H A. et al . A sustained mortality benefit from screening for abdominal aortic aneurysm. Ann Intern Med. 2007; 146 699-706
- 40 Wanhainen A, Lundgren E, Bergqvist D. et al . Abdominal aortic aneurysm screening starts now. First out with the invitation of all 65-year old men is the county of Uppsala. Lakartidningen. 2006; 103 2038-2039
- 41 Multicentre aneurysm screening study (MASS): cost effectiveness analysis of screening for abdominal aortic aneurysms based on four year results from randomised controlled trial. BMJ. 2002; 325 1135
- 42 Wilmink A B, Quick C R, Hubbard C S. et al . Effectiveness and cost of screening for abdominal aortic aneurysm: results of a population screening program. J Vasc Surg. 2003; 38 72-77
- 43 Sonnenberg A, Delco F. Cost-effectiveness of a single colonoscopy in screening for colorectal cancer. Arch Intern Med. 2002; 162 163-168
- 44 Stout N K, Rosenberg M A, Trentham-Dietz A. et al . Retrospective cost-effectiveness analysis of screening mammography. J Natl Cancer Inst. 2006; 98 774-782
- 45 Allen B T, Hovsepian D M, Reilly J M. et al . Endovascular stent grafts for aneurysmal and occlusive vascular disease. Am J Surg. 1998; 176 574-580
- 46 Campbell H, Briggs A, Buxton M. et al . The credibility of health economic models for health policy decision-making: the case of population screening for abdominal aortic aneurysm. J Health Serv Res Policy. 2007; 12 11-17
- 47 Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet. 2005; 365 2179-2186
- 48 Greenhalgh R M, Brown L C, Kwong G P. et al . Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet. 2004; 364 843-848
- 49 Prinssen M, Buskens E, Blankensteijn J D. The Dutch Randomised Endovascular Aneurysm Management (DREAM) trial. Background, design and methods. J Cardiovasc Surg. 2002; 43 379-384
- 50 Franks S C, Sutton A J, Bown M J. et al . Systematic review and meta-analysis of 12 years of endovascular abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2007; 33 154-171
- 51 Hynes N, Sultan S. A Prospective Clinical, Economic, and Quality-of-Life Analysis Comparing Endovascular Aneurysm Repair (EVAR), Open Repair, and Best Medical Treatment in High-Risk Patients With Abdominal Aortic Aneurysms Suitable for EVAR: The Irish Patient Trial. J Endovasc Ther. 2007; 14 763-776
- 52 Aune S, Laxdal E, Pedersen G. et al . Lifetime gain related to cost of repair of ruptured abdominal aortic aneurysm in octogenarians. Eur J Vasc Endovasc Surg. 2004; 27 299-304
Dr. Andreas Chemelli
Radiologie I, Universitätsklinikum Innsbruck
Anichstraße 35
6020 Innsbruck
Austria
Telefon: ++ 43/5 12/50 48 05 81
Fax: ++ 43/5 21/50 42 27 58
eMail: andreas.chemelli@i-med.ac.at