Screening for abdominal aortic aneurysm: A computer assisted cost-utility analysis

Objectives:To evaluate the effects of introducing routine ultrasonic screening for the identification and elective surgical treatment of abdominal aortic aneurysms (AAA) at high risk of rupture in the U.K. population of men aged 65–74 years.Design:A computer assisted simulation of an AAA screening programme. The simulation incorporated assumptions gleaned from the literature about the epidemiology of AAA and the costs of screening. In addition, up to date costings based on recent Manchester (U.K.) vascular surgery experience are used.Setting:A dialogue between National Health Service commissioners and providers to explore the feasibility and desirability of introducing AAA screening.Chief outcome measure:Cost per quality adjusted life year (QALY) gained.Main results:The absolute cost (circa 1992/3) per QALY gained from screening for and treating aneurysms of ≥ 6cm in diameter is £1500 (benefit not discounted). Offsetting current treatment costs of ruptured aneurysms gives a net additional cost per QALY of £1300. Screening and treating aneurysms of ≥ 5cm leads to a cost per QALY gained exceeding £20000. The findings are robust under sensitivity analysis.Conclusions:Routine screening for AAAs of size ≥ 6cm compares favourably in terms of cost per QALY gained with services such as breast and cervical cancer screening