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• W2341039099 abstract "The multi-specialty Malmö group has performed a thorough analysis of cost efficiency in screening for abdominal aortic aneurysms (AAA), despite there being a lower incidence now than 20 years ago.1Zarrouk M. Lundqvist A. Holst J. Troëng T. Gottsäter A. Cost-effectiveness of screening for abdominal aortic aneurysm in combination with medical intervention in patients with small aneurysms.Eur J Vasc Endovasc Surg. 2016; 51: 766-773Abstract Full Text Full Text PDF Scopus (23) Google Scholar, 2Sidloff D. Stather P. Dattani N. Bown M. Thompson J. Sayers R. et al.Aneurysm global epidemiology study: public health measures can further reduce abdominal aortic aneurysm mortality.Circulation. 2014; 129: 747-753Crossref PubMed Scopus (139) Google Scholar This lower prevalence is not equally distributed worldwide, with a faster decline in well developed countries. As a true cost analysis would take a long time to perform, in addition to being cost intensive, the authors used the Markov model with different assumptions. In their nearly 80% attendance rate, which seems to also apply to other regions in Sweden,3Hager J. Lanne T. Carlsson P. Lundgren F. Lower prevalence than expected when screening 70 year old men for abdominal aortic aneurysm.Eur J Vasc Endovasc Surg. 2013; 46: 453-459Abstract Full Text Full Text PDF PubMed Scopus (30) Google Scholar 0.14% of attendees had an AAA with a diameter of >5.5 cm and 0.21% had AAAs with diameters of 4.5–5.4 cm, 43% of which increased in diameter to >5.5 cm within one year. However, the authors still found it worthwhile, in their economic environment, to perform screening, as the price for a gained quality adjusted life year (QALY) was about €16,000. This sum is well below the accepted €50,000 for a QALY in some European countries (e.g., the UK, The Netherlands), even when used for other diagnoses and being age dependent. In order to consider the data in regard to a wider geographical application, four major factors could be considered: (i) attendance rate; (ii) cost of ultrasound; (iii) cost of operation; and (iv) prevalence of the AAA. With regard to (i), the attendance rate for screening (including other diagnoses such as breast, colonic, and prostate cancer) seems to differ between countries, with lower attendance rates, for example, in Germany (∼50%) and Italy (55–60%) but The Netherlands reports 83% and England 75–80% attendance. According to Wanhainen's group, though, the attendance rate had little effect on the cost effectiveness ratio in women.4Wanhainen A. Lundkvist J. Bergqvist D. Bjorck M. Cost-effectiveness of screening women for abdominal aortic aneurysm.J Vasc Surg. 2006; 43: 908-914Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar Considering point (ii), the cost of ultrasound also differs between different countries, especially the personnel costs. Thus, in some countries this cost may be much lower than that in Malmö (€90) but higher than in others. With regard to (iii), the same arguments may be used for the cost of operation, where several countries' surgical costs are lower, be it open repair (OR) or endovascular (EVAR). For example, in Germany, OR for an AAA is reimbursed at €9,742 and EVAR at €16,017. This would then make the screening even more cost-effective if the same price for a QALY is accepted. Finally, considering (iv), the prevalence of AAA is declining, such as in Scandinavia and the Netherlands, where the statistics are relatively reliable. In several other countries the true prevalence might be less accurate, although one study from the UK suggests the same, and recommends screening above the age of 75 years.5Howard D.P.J. Banerjee A. Fairhead J.F. Handa A. Silver L.E. Rothwell P.M. et al.Population-based study of incidence of acute abdominal aortic aneurysms with projected impact of screening strategy.J Am Heart Assoc. 2015; 4: e001926Google Scholar Unfortunately, there are no epidemiological AAA data available from countries that have easy access to diagnostic tools such as ultrasound, computed tomography, and magnetic resonance imaging. The high user rate of such tools might reduce the number of undetected AAA in the population if many aneurysms are found accidentally with other diagnoses like colonic cancer.6Khashram M. Jones G.T. Roake J.A. Prevalence of abdominal aortic aneurysm (AAA) in a population undergoing computed tomography colonography in Canterbury, New Zealand.Eur J Vasc Endovasc Surg. 2015; 50: 199-205Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar In summary, the article by Zarrouk et al. states that screening in their health organisation is cost effective,1Zarrouk M. Lundqvist A. Holst J. Troëng T. Gottsäter A. Cost-effectiveness of screening for abdominal aortic aneurysm in combination with medical intervention in patients with small aneurysms.Eur J Vasc Endovasc Surg. 2016; 51: 766-773Abstract Full Text Full Text PDF Scopus (23) Google Scholar but this needs to be cross checked in other systems before being generally implemented. Cost-effectiveness of Screening for Abdominal Aortic Aneurysm in Combination with Medical Intervention in Patients with Small AneurysmsEuropean Journal of Vascular and Endovascular SurgeryVol. 51Issue 6PreviewScreening 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 Malmö 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. Full-Text PDF Open Archive" @default.
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• W2341039099 title "Commentary on ‘Cost-effectiveness of Screening for Abdominal Aortic Aneurysm in Combination with Medical Intervention in Patients with Small Aneurysms’" @default.
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