Conflicting cost-effectiveness results for AAA screening
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It pays in the UK Researchers from the Multicentre Aneurysm Screening Study (MASS) suggest that screening for AAA in men aged 65-74 years would be cost effective.1 In MASS, 33 883 such men were randomised to the screening group (27 204 attended the initial scan) and 33 887 to a control group. Of the 1334 aneurysms (≥ 3.0cm in diameter) detected by screening, those sized 3.0–4.4 cm were scheduled for annual scans, and those sized 4.5–5.4cm for 3-monthly scans; larger, rapidly growing or symptomatic aneurysms were referred for a surgical review. Cost-effectiveness was determined using the MASS 10-year data and UK national data, from a UK health service perspective; costs were converted to reflect 2008-9 prices. Overall, there were 155 deaths associated with AAAs in the screening group, compared with 296 in the control group; this equated to a significant 48% reduction in relative risk. Although the cost per person were greater by an average of £100 with screening, the fewer deaths led to an incremental cost-effectiveness ratio (ICER) of £7600 per life year gained. The researchers concluded that their result "is well below the guideline figure of around £25 000 per life year gained for the acceptance of medical technologies and interventions in the NHS."
Danes disagree However, researchers from Denmark found that screening for AAA was not cost-effective in a similar analysis.2 They utilised a decision tree and Markov model to assess the cost effectiveness of screening and not screening for AAA in a cohort of men aged 65 years, from a health care perspective. Data from MASS, the Danish Vascular Registry, and other Danish national sources were incorporated; costs were in 2007 prices. Overall, the ICER for the base case was £43 485 per QALY; one-way sensitivity analyses with a 30% and a 50% probability of reaching hospital alive with rupture resulted in ICERs of £32 640 per QALY and £66 001 per QALY, respectively. The chance of screening being cost effective was < 30% at a willingness-to-pay threshold of £30 000.
Screening for AAA A-OK? In an accompanying editorial, Professor Martin J Buxton from Brunel University, Uxbridge, UK, considered the results from both studies, but contends that "the accumulated evidence suggests that a national screening programme in the UK is appropriate and likely to be cost effective", although ongoing monitoring is required.3 1. Thompson SG, et al. Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study. BMJ 338: 1538-1541, No. 7710, 27 Jun 2009. 2. Ehlers L, et al. Analysis of cost effectiveness of screening Danish men aged 65 for abdominal aortic aneurysm. BMJ 338: 1542-1544, No. 7710, 27 Jun 2009. 3. Buxton MJ. Screening for abdominal aortic aneurysm. BMJ 338: 1509-1510, No. 7710, 27 Jun 2009. 801140080
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PharmacoEconomics & Outcomes News 11 Jul 2009 No. 582
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