Journal of Medical Screening > Volume 14, Number 1 > Pp. 46-52

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Original Articles

How cost-effective is screening for abdominal aortic aneurysms?

L G Kim, S G Thompson, A H Briggs, M J Buxton and H E Campbell , MRC Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge CB2 2SR, UK; MRC Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge CB2 2SR, UK; Section of Public Health and Health Policy, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK; Health Economics Research Group, Brunel University, Uxbridge, Middlesex UB8 3PH, UK; Health Economics Research Centre, University of Oxford, Department of Public Health, Old Road Campus, Headington, Oxford OX3 7LF, UK

Objective: To provide reliable estimates of the long-term cost-effectiveness of abdominal aortic aneurysm screening in men.

Methods: A Markov health economic decision model for screening is described and extrapolated to 30 years. The strategy modelled involves a one-off scan at age 65 years, with annual and three-monthly follow-up scans for small and medium aneurysms, respectively. Referral for elective surgery occurs at an aortic diameter of 5.5 cm. Model parameters are estimated from patient-level data from the UK Multi-centre Aneurysm Screening Study. Model structure is validated on this trial's data, and input parameter uncertainty is addressed by probabilistic sensitivity analysis. Costs and life-years gained are obtained for both screening and no systematic screening strategies.

Results: Cost-effectiveness improves dramatically when considered over longer timescales. Taking a 30-year perspective, screening for abdominal aortic aneurysms in men is highly cost-effective at £2320 per life-year gained (95% uncertainty interval: £1600 to £4240). Adjusting life-years for the age-specific health-related quality of life experienced in this population gave a figure of £2970 (95% uncertainty interval: £2030 to £5430) per quality-adjusted life-year gained. The additional cost of screening the UK male population is estimated to be £19 m per year.

Conclusions: The long-term cost-effectiveness of screening for abdominal aortic aneurysms in men is highly attractive and this evidence provides further support for a national screening programme in the UK.

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