BMJ. 2002 Nov 16;325(7373):1135. doi: 10.1136/bmj.325.7373.1135.
To assess the cost effectiveness of ultrasound screening for abdominal aortic aneurysms.
Primary analysis: four year cost effectiveness analysis based directly on results from a randomised controlled trial in which patients were individually allocated to invitation to ultrasound screening (intervention) or to a control group not offered screening. Secondary analysis: projection of the data, based on conservative assumptions, to indicate likely cost effectiveness at 10 years.
Four centres in the United Kingdom. Screening delivered in primary care settings with follow up and surgery offered in the main hospitals Participants: Population based sample of 67 800 men aged 65-74 years.
Mortality from and costs (screening, follow up, elective and emergency surgery) related to abdominal aortic aneurysm; cost per life year gained.
Over four years there were 47 fewer deaths related to abdominal aortic aneurysms in the screening group than in the control group, but the additional costs incurred were pound 2.2m. After adjustment for censoring and discounted at 6% the mean additional cost of the screening programme was pound 63.39 ($97.77, euro;100.48) (95% confidence interval pound 53.31 to pound 73.48) per patient. The hazard ratio for abdominal aortic aneurysm was 0.58 (0.42 to 0.78). Over four years the mean incremental cost effectiveness ratio for screening was pound 28 400 ( pound 15 000 to pound 146 000) per life year gained, equivalent to about pound 36 000 per quality adjusted life year. After 10 years this figure is estimated to fall to around pound 8000 per life year gained.
Even at four years the cost effectiveness of screening for abdominal aortic aneurysms is at the margin of acceptability according to current NHS thresholds. Over a longer period the cost effectiveness will improve substantially, the predicted ratio at 10 years falling to around a quarter of the four year figure.
评估超声筛查腹主动脉瘤的成本效益。
主要分析：基于一项随机对照试验的结果进行为期四年的成本效益分析，该试验中患者被分别分配至接受超声筛查邀请（干预组）或未提供筛查的对照组。次要分析：基于保守假设对数据进行预测，以表明10年时可能的成本效益。
英国的四个中心。在基层医疗场所进行筛查，并在主要医院进行随访和手术。参与者：基于人群的67800名65 - 74岁男性样本。
与腹主动脉瘤相关的死亡率及成本（筛查、随访、择期和急诊手术）；每获得一个生命年的成本。
四年间，筛查组与腹主动脉瘤相关的死亡人数比对照组少47例，但额外产生的成本为220万英镑。在对删失数据进行调整并按6%的贴现率计算后，筛查项目的人均额外成本为63.39英镑（97.77美元，95.35欧元）（95%置信区间为53.31英镑至73.48英镑）。腹主动脉瘤的风险比为0.58（0.42至0.78）。四年间，筛查的平均增量成本效益比为每获得一个生命年28400英镑（15000英镑至146000英镑），相当于每获得一个质量调整生命年约36000英镑。10年后，这一数字预计降至每获得一个生命年约8000英镑。
即使在四年时，根据当前英国国家医疗服务体系（NHS）的阈值，腹主动脉瘤筛查的成本效益也处于可接受的边缘。在更长时期内，成本效益将大幅提高，预计10年时的比率将降至四年时数字的约四分之一。
