Feasibility and Efficiency Study of a Population-Based Abdominal Aortic Aneurysm Screening Program in Men and Women in Spain
| Autor: | Sergi Bellmunt-Montoya, Silvia Zamora, Teresa Puig, José Román Escudero, Raquel Gayarre-Aguado, Judit Solà Roca, Joan Fité |
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| Rok vydání: | 2020 |
| Předmět: |
Diagnostic Screening Programs
Male Pediatrics medicine.medical_specialty Time Factors Cost-Benefit Analysis Cardiovascular risk factors Population Pilot Projects Population based 030204 cardiovascular system & hematology Asymptomatic 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests medicine Prevalence Humans Sex Distribution education Aged education.field_of_study Ultrasonography Doppler Duplex Primary Health Care business.industry Mortality reduction General Medicine Health Care Costs medicine.disease Abdominal aortic aneurysm Abdominal aortic aneurysm screening Spain Life expectancy cardiovascular system Feasibility Studies Surgery Female Quality-Adjusted Life Years medicine.symptom Cardiology and Cardiovascular Medicine business Aortic Aneurysm Abdominal |
| Zdroj: | ANNALS OF VASCULAR SURGERY r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname |
| ISSN: | 1615-5947 0890-5096 |
| Popis: | 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 13,664V per quality-adjusted life years at a 10-year horizon and 39,455V 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. |
| Databáze: | OpenAIRE |
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