Feasibility and Efficiency Study of a Population-Based Abdominal Aortic Aneurysm Screening Program in Men and Women in Spain.

Autor:	Fite J; Vascular Surgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Vascular Biology and Inflammation Laboratory, CIBER Cardiovascular, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain., Gayarre-Aguado R; General Practitioner in Primary Care Team EAP Encants, Barcelona, Spain., Puig T; Universitat Autònoma de Barcelona, Barcelona, Spain; Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBER Cardiovascular, Biomedical Research Institute Sant Pau, Barcelona, Spain. Electronic address: tpuig@santpau.cat., Zamora S; General Practitioner in Primary Care Team EAP Dreta Eixample, Barcelona, Spain., Escudero JR; Vascular Surgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Vascular Biology and Inflammation Laboratory, CIBER Cardiovascular, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain., Solà Roca J; Universitat Autònoma de Barcelona, Barcelona, Spain; Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, CIBER Cardiovascular, Biomedical Research Institute Sant Pau, Barcelona, Spain., Bellmunt-Montoya S; Universitat Autònoma de Barcelona, Barcelona, Spain; Vascular Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Institut de Recerca Vall Hebron, Barcelona, Spain.
Jazyk:	angličtina
Zdroj:	Annals of vascular surgery [Ann Vasc Surg] 2021 May; Vol. 73, pp. 429-437. Date of Electronic Publication: 2020 Dec 30.
DOI:	10.1016/j.avsg.2020.11.042
Abstrakt:	Background: Based on current evidence, one-time screening for abdominal aortic aneurysm (AAA) in men using ultrasound evaluation reduces mortality related to AAA rupture and is considered cost-effective, although all-cause mortality reduction still remains in question. In Spain, there is no population screening program for AAA, so the aim of our study was to perform a pilot population screening program in our area to assess feasibility and efficiency of an AAA screening program for men and women. Methods: A population AAA screening pilot program was performed in a Barcelona area, including 400,000 inhabitants. According to inclusion criteria, 4,730 individuals aged 65 years at the moment of the trial were invited for screening (2,089 men and 2,641 women). Primary care doctors, trained in duplex ultrasound abdominal evaluations, performed an abdominal aortic measurement. Individuals with a previous diagnosis of AAA, limited life expectancy, or wrong contact data were excluded. Participation data, aortic diameters, AAA prevalence, and related cardiovascular risk factors were analyzed. The results were used in a cost-utility model to assess the efficiency of the screening program. Results: Participation was 50.3% in men and 44% in women. Eleven patients were excluded because of previously diagnosed AAA. Five new asymptomatic AAA were detected in 65-year-old men (0.5% prevalence), all being active smokers. When considering patients excluded for previous AAA diagnosis, the prevalence in 65-year-old men reached 1.4%. Global AAA prevalence in smoking men reached 2.67%. No AAA was detected in women. Subaneurysmal aorta prevalence in men was 2.9% (n = 29), and in women, it was 0.08% (n = 2). A cost-utility analysis model on screening versus no screening retrieved 13,664€ per quality-adjusted life years at a 10-year horizon and 39,455€ per quality-adjusted life years at a 30-year horizon. Conclusions: AAA population-based screening by ultrasound evaluation in primary care is logistically feasible in our area. Despite that, AAA prevalence is lower than expected in men, and null in women. Cost-utility model results indicate that a local AAA screening program is only efficient in a 30 years' time horizon. Such inefficient results for a population screening make it necessary to consider other strategies such as opportunistic or subgroup screening in our area. (Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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