Benefit, Risks and Cost-Effectiveness of Screening for Abdominal Aortic Aneurysm

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

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