A sustained mortality benefit from screening for abdominal aortic aneurysm

Area of Science:

• Vascular Surgery
• Public Health
• Health Economics

Background:

• Uncertainty exists regarding the long-term mortality benefit and cost-effectiveness of abdominal aortic aneurysm (AAA) screening.
• Previous studies have not fully established the sustained impact of AAA screening programs.

Purpose of the Study:

• To estimate the long-term benefits of AAA screening on AAA-related and all-cause mortality.
• To assess the cost-effectiveness of AAA ultrasonography screening at a mean 7-year follow-up.

Main Methods:

• A randomized trial involving 67,770 men aged 65-74 across 4 UK centers.
• Participants were invited (intervention) or not invited (control) for AAA ultrasonography screening.
• Mortality data and cost-effectiveness were analyzed using national databases and unit costs.

Main Results:

• Screening invitation significantly reduced AAA-related mortality (Hazard Ratio: 0.53).
• All-cause mortality showed a non-significant reduction (Hazard Ratio: 0.96).
• Cost-effectiveness was estimated at $19,500 per life-year gained (AAA-related mortality) and $7,600 (all-cause mortality).

Conclusions:

• Long-term mortality benefits of AAA screening ultrasonography are maintained.
• Screening demonstrates improving cost-effectiveness over time.
• Potential underestimation of treatment effect due to unspecified aortic aneurysm deaths noted.