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Ann Intern Med. 2007 May 15;146(10):699-706.

A sustained mortality benefit from screening for abdominal aortic aneurysm.

Author information

1
Institute of Public Health, Cambridge, United Kingdom, and St. Richard's Hospital, Chichester, United Kingdom. lois.kim@mrc-bsu.cam.ac.uk

Erratum in

  • Ann Intern Med. 2007 Aug 7;147(3):216.

Abstract

BACKGROUND:

Longer-term mortality benefit and cost-effectiveness for abdominal aortic aneurysm (AAA) screening are uncertain.

OBJECTIVE:

To estimate the benefits, in terms of AAA-related and all-cause mortality, and cost-effectiveness of ultrasonography screening for AAA in a group that was invited to screening compared with a group that was not invited at a mean 7-year follow-up.

DESIGN:

Randomized trial.

SETTING:

4 centers in the United Kingdom.

PATIENTS:

Population-based sample of 67,770 men age 65 to 74 years.

INTERVENTION:

Patients with an AAA detected at screening had surveillance and were offered surgery after predefined criteria were met.

MEASUREMENTS:

Mortality data were obtained after flagging on the national database. Unit costs obtained from large samples were applied to individual event data for the cost analysis.

RESULTS:

The hazard ratio was 0.53 (95% CI, 0.42 to 0.68) for AAA-related mortality in the group invited for screening. The rupture rate in men with normal results on initial ultrasonography has remained low: 0.54 rupture (CI, 0.25 to 1.02 ruptures) per 10 000 person-years. In terms of all-cause mortality, the observed hazard ratio was 0.96 (CI, 0.93 to 1.00). At the 7-year follow-up, cost-effectiveness was estimated at $19 500 (CI, $12,400 to $39,800) per life-year gained based on AAA-related mortality and $7600 (CI, $3300 to infinity) per life-year gained based on all-cause death. (All values are reported in U.S. dollars [U.K. 1 pound sterling = U.S. $1.58]).

LIMITATION:

Inclusion of deaths from aortic aneurysm at an unspecified site, which may include some thoracic aortic aneurysms, may have underestimated the treatment effect.

CONCLUSIONS:

These results from a large, pragmatic randomized trial show that the early mortality benefit of screening ultrasonography for AAA is maintained in the longer term and that the cost-effectiveness of screening improves over time. International Standard Randomized Controlled Trial registration number: ISRCTN37381646.

[Indexed for MEDLINE]

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