Cost-effectiveness of Screening for Abdominal Aortic Aneurysm in Combination with Medical Intervention in Patients with Small Aneurysms
| Autor: | Jan Holst, Anders Gottsäter, Anita Lundqvist, Thomas Troëng, Moncef Zarrouk |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Cost effectiveness Aortic Rupture Cost-Benefit Analysis medicine.medical_treatment 030204 cardiovascular system & hematology Endovascular aneurysm repair 03 medical and health sciences 0302 clinical medicine Intervention (counseling) medicine Humans Mass Screening In patient cardiovascular diseases 030212 general & internal medicine Aged Sweden business.industry Health Care Costs medicine.disease Abdominal aortic aneurysm Quality-adjusted life year Surgery Blood pressure Cohort Emergency medicine cardiovascular system Quality-Adjusted Life Years Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures Aortic Aneurysm Abdominal |
| Zdroj: | European Journal of Vascular and Endovascular Surgery. 51:766-773 |
| ISSN: | 1078-5884 |
| DOI: | 10.1016/j.ejvs.2015.12.048 |
| Popis: | Objectives Screening for abdominal aortic aneurysm (AAA) among 65 year old men has been proven cost-effective, but nowadays is conducted partly under new conditions. The prevalence of AAA has decreased, and endovascular aneurysm repair (EVAR) has become the predominant surgical method for AAA repair in many centers. At the Malmo Vascular Center pharmacological secondary prevention with statins, antiplatelet therapy, and blood pressure reduction is initiated and given to all patients with AAA. This study evaluates the cost-effectiveness of AAA screening under the above mentioned conditions. Methods This was a Markov cohort simulation. A total of 4,300 65 year old men were invited to annual AAA screening; the attendance rate was 78.3% and AAA prevalence was 1.8%. A Markov model with 11 health states was used to evaluate cost-effectiveness of AAA screening. Background data on rupture risks, costs, and effectiveness of surgical interventions were obtained from the participating unit, the national Swedvasc Registry, and from the scientific literature. Results The additional costs of the screening strategy compared with no screening were €169 per person and year. The incremental health gain per subject in the screened cohort was 0.011 additional quality adjusted life years (QALYs), corresponding to an incremental cost-effectiveness ratio (ICER) of €15710 per QALY. Assuming a 10% reduction of all cause mortality, the incremental cost of screening was €175 per person and year. The gain per subject in the screened cohort was 0.013 additional QALYs, corresponding to an ICER of €13922 per QALY Conclusions AAA screening remains cost-effective according to both the Swedish recommendations and the UK National Institute for Health and Care Excellence recommendations in the new era of lower AAA prevalence, EVAR as the predominant surgical method, and secondary prevention for all AAA patients. |
| Databáze: | OpenAIRE |
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