Cost-effectiveness of different screening strategies for abdominal aortic aneurysm

ObjectiveThe 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.MethodsA 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.ResultsThe cost per life year gained for different screening strategies ranged from $8,309 to $14,084 and was estimated at $10,474 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 ($10,695) or cardiovascular patients ($10,392). Assuming general population utility resulted in a cost per quality-adjusted life year (QALY) gained of $13,900, whereas a hypothetical 5% reduction in utility among men with a screening-detected AAA raised the cost per QALY gained to $75,100.ConclusionThis 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