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Analysis of clinical benefit, harms, and cost-effectiveness of screening women for abdominal aortic aneurysm

Sweeting, Michael J, Masconi, Katya L, Jones, Edmund, Ulug, Pinar, Glover, Matthew J, Michaels, Jonathan A, Bown, Matthew J, Powell, Janet T and Thompson, Simon G (2018) Analysis of clinical benefit, harms, and cost-effectiveness of screening women for abdominal aortic aneurysm The Lancet, 392 (10146). pp. 487-495.

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Abstract

Background

A third of deaths in the UK from ruptured abdominal aortic aneurysm (AAA) are in women. In men, national screening programmes reduce deaths from AAA and are cost-effective. The benefits, harms, and cost-effectiveness in offering a similar programme to women have not been formally assessed, and this was the aim of this study.

Methods

We developed a decision model to assess predefined outcomes of death caused by AAA, life years, quality-adjusted life years, costs, and the incremental cost-effectiveness ratio for a population of women invited to AAA screening versus a population who were not invited to screening. A discrete event simulation model was set up for AAA screening, surveillance, and intervention. Relevant women-specific parameters were obtained from sources including systematic literature reviews, national registry or administrative databases, major AAA surgery trials, and UK National Health Service reference costs.

Findings

AAA screening for women, as currently offered to UK men (at age 65 years, with an AAA diagnosis at an aortic diameter of ≥3·0 cm, and elective repair considered at ≥5·5cm) gave, over 30 years, an estimated incremental cost-effectiveness ratio of £30 000 (95% CI 12 000–87 000) per quality-adjusted life year gained, with 3900 invitations to screening required to prevent one AAA-related death and an overdiagnosis rate of 33%. A modified option for women (screening at age 70 years, diagnosis at 2·5 cm and repair at 5·0 cm) was estimated to have an incremental cost-effectiveness ratio of £23 000 (9500–71 000) per quality-adjusted life year and 1800 invitations to screening required to prevent one AAA-death, but an overdiagnosis rate of 55%. There was considerable uncertainty in the cost-effectiveness ratio, largely driven by uncertainty about AAA prevalence, the distribution of aortic sizes for women at different ages, and the effect of screening on quality of life.

Interpretation

By UK standards, an AAA screening programme for women, designed to be similar to that used to screen men, is unlikely to be cost-effective. Further research on the aortic diameter distribution in women and potential quality of life decrements associated with screening are needed to assess the full benefits and harms of modified options.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine
Authors :
NameEmailORCID
Sweeting, Michael J
Masconi, Katya L
Jones, Edmund
Ulug, Pinar
Glover, Matthew Jmatthew.glover@surrey.ac.uk
Michaels, Jonathan A
Bown, Matthew J
Powell, Janet T
Thompson, Simon G
Date : 11 August 2018
Funders : Medical Research Council (MRC), British Heart Foundation, National Institute for Health Research (NIHR)
DOI : 10.1016/S0140-6736(18)31222-4
OA Location : https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)31222-4.pdf
Copyright Disclaimer : © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licence.
Depositing User : Clive Harris
Date Deposited : 29 Apr 2020 15:22
Last Modified : 29 Apr 2020 15:22
URI: http://epubs.surrey.ac.uk/id/eprint/855407

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