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Changing Conditions - the same Conclusion: Cost-effective to Screen for Abdominal Aortic Aneurysm among 65-year-old Men, based on Data from an Implemented Screening Programme
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Center for Medical Image Science and Visualization (CMIV). Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.ORCID iD: 0000-0002-9095-403X
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2014 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Health economic analyses based on randomized trials have shown that screening for abdominal aortic aneurysm (AAA) cost-effectively decreases AAA-related as well as allcause mortality. However, results from running screening programmes now reveal substantially changed conditions in terms of prevalence, attendance rate, costs and mortality after intervention. Our aim was to evaluate whether screening for AAA among 65-year-old men on a general basis is cost-effective under current clinical practice.

Methods: A decision-analytic model, previously used to show the cost-effectiveness of an AAA-screening programme before decision to introduce screening in practice, was updated using results from implemented screening-programmes as well as data from contemporary published data and the Swedvasc registry.

Results: The base-case analysis showed that the cost per life-year gained and quality-adjusted life year (QALY) gained were 3252 € and 4231 €, respectively. The probability of screening being cost-effective was high.

Conclusion: Despite profound changes in disease pattern and AAA-management, the current results are similar to those reported almost 10 years ago, and thus screening 65-year-old men for AAA still appears to be cost-effective.

Place, publisher, year, edition, pages
2014.
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-102928OAI: oai:DiVA.org:liu-102928DiVA: diva2:684506
Available from: 2014-01-08 Created: 2014-01-08 Last updated: 2017-03-27Bibliographically approved
In thesis
1. Abdominal Aortic Aneurysm: Aspects on how to affect mortality from rupture
Open this publication in new window or tab >>Abdominal Aortic Aneurysm: Aspects on how to affect mortality from rupture
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Abdominal Aortic Aneurysm (AAA) is a disease that mainly affects elderly men, and ruptured AAA (rAAA) is associated with a mortality of > 80%. AAA seldom gives any symptoms prior to rupture.

The aims of this thesis were to investigate different aspects of how to affect mortality from rAAA.

In Study I, we identified 849 patients treated for rAAA during 1987-2004, and studied the 30-day survival after surgery, depending on whether they came directly to the treating hospital (one-stop) or were transferred via another hospital (two-stop). A two-stop referral pattern resulted in a 27% lower population-based survival rate for patients 65-74 years of age. However, the consequences would be small even if a one-stop referral pattern could be generally accomplished, due to the huge over-all mortality related to rAAA, hence an argument to find and treat AAA before rupture, e.g. by screening.

In Study II, we examined the AAA-prevalence and the risk factors for AAA among 70-year-old men. The screening-detected AAA-prevalence was 2.3%, thus less than half the predicted. The most important risk factor was smoking.

In Study III, we compared the screening-detected AAA-prevalence, the attendance rate, and the rate of opportunistic detection of AAA, between almost 8000 65- and 6000 70-year-old men. There was no difference in the screening-detected prevalence; probably due to the fact that almost 40% of the AAAs among the 70-year-old were already known prior to screening, compared to roughly 25% in the 65-year-old. The attendance rate was higher among the 65-year-old men, 85.7% compared 84.0% in the 70-year-old. Thus, there is no benefit of screening for AAA among 70- instead of 65-year-old men.

In Study IV, a cost-effectiveness analysis, we found that screening for AAA still appears to be cost-effective, despite profound changes in disease pattern and AAA-management.

In conclusion, we found that mortality from rAAA is not affected in any substantial way by different referral patterns and hence centralisation of services for AAA/rAAA is not a solution. A better alternative is to prevent rupture through early detection by screening. Screening 65-year-old men for AAA still appears to be cost-effective, despite profound changes in disease pattern and AAA-management during the last decade. Screening 70- instead of 65-year-old men will not increase the efficacy of screening.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. 113 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1381
Keyword
abdominal aortic aneurysm rupture AAA rAAA screening one-stop two stop prevalence risk factor cost-effectiveness
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-102482 (URN)10.3384/diss.diva-102482 (DOI)978-91-7519-503-2 (ISBN)
Public defence
2014-01-31, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Heart Lung FoundationCounty Council of Östergötland
Available from: 2014-01-08 Created: 2013-12-12 Last updated: 2017-03-27Bibliographically approved

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Hager, JakobHenriksson, MartinCarlsson, PerLänne, TosteLundgren, Fredrik

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Hager, JakobHenriksson, MartinCarlsson, PerLänne, TosteLundgren, Fredrik
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Division of Cardiovascular MedicineFaculty of Health SciencesDepartment of Thoracic and Vascular SurgeryDivision of Health Care AnalysisCenter for Medical Image Science and Visualization (CMIV)
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