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J Vasc Surg. 2005 May;41(5):741-51; discussion 751.

Cost-effectiveness of different screening strategies for abdominal aortic aneurysm.

Author information

1
Department of Surgery, Uppsala University Hospital, SE-371- 85 Uppsala, Sweden. andwan@algonet.se

Abstract

OBJECTIVE:

The primary objective of this study was to develop a simulation model to assess the cost-effectiveness of different screening strategies for abdominal aortic aneurysms (AAAs) in men.

METHODS:

A systematic review of the literature was conducted for different screening strategies in terms of age (60, 65, or 70 years) and risk profiles (all men or specific high-risk groups) of the screened population, and rescreening after 5 or 10 years. These data were analyzed in a Markov simulation cohort model.

RESULTS:

The cost per life year gained for different screening strategies ranged from US 8,309 dollars to US 14,084 dollars and was estimated at US 10,474 dollars when 65-year-old men were screened once. Screening 60-year-old men was equally cost-effective, with the advantage of more life years gained. We demonstrated a trade-off between high prevalence of AAA and lower life expectancy, eliminating the expected benefits of screening high-risk groups such as smokers (US 10,695 dollars) or cardiovascular patients (US 10,392 dollars). Assuming general population utility resulted in a cost per quality-adjusted life year (QALY) gained of US 13,900 dollars, whereas a hypothetical 5% reduction in utility among men with a screening-detected AAA raised the cost per QALY gained to US 75,100 dollars.

CONCLUSION:

This Markov model, which was based on a systematic review of the literature, supplied information on the estimated cost-effectiveness of different screening strategies. Screening men for AAA may be cost-effective in the long-term. Different screening strategies and quality-of-life effects related to screening for AAA need to be evaluated in future clinical studies.

PMID:
15886653
DOI:
10.1016/j.jvs.2005.01.055
[Indexed for MEDLINE]
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