Screening for abdominal aortic aneurysms in men: a Canadian perspective using Monte Carlo-based estimates

Area of Science:

• Vascular Surgery
• Health Economics
• Public Health Policy

Background:

• Randomized trials indicate routine screening for abdominal aortic aneurysm (AAA) reduces AAA-related deaths in men aged 65+.
• Economic evaluation is crucial for assessing the relevance of a national AAA screening program in Canada.

Purpose of the Study:

• To assess the incremental cost-utility of a routine AAA screening program for 65-year-old men in Canada.
• To inform decision-makers regarding the implementation of a national screening program.

Main Methods:

• A 14-state Markov model was developed comparing screening via ultrasonography (US) versus opportunistic detection.
• Lifetime outcomes including life-years gained, AAA rupture avoided, QALYs, and costs were analyzed.
• Probabilistic sensitivity analysis was performed to assess uncertainty.

Main Results:

• Screening yielded a gain of 0.049 life-years and 0.019 QALYs per person at an incremental cost of CAN$118.
• The incremental cost-utility ratio was CAN$6194 per QALY gained.
• 187 men needed to be invited and 137 screened to prevent one AAA-related death.

Conclusions:

• A national AAA screening program for 65-year-old men in Canada is economically viable.
• Further research is needed to define screening's role in high-risk subgroups, particularly women.