Lindholt Jes S, Juul Svend, Fasting Helge, Vammen Sten, Henneberg Eskild W
Viborg-Kjellerup Sygehus, organkirurgisk afdeling, karkirurgisk sektion. Aarhus Universitet, Institut for Epidemiologi og Socialmedicin.
Ugeskr Laeger. 2003 Feb 3;165(6):579-83.
The hospital costs and benefits of screening older males for abdominal aortic aneurysms (AAA) are unknown.
In 1994, a hospital-based screening trial of 12,658 65-73-year-old males in the County of Viborg, Denmark, was started. AAA > 5 cm were referred for surgery. The remaining AAA were offered annual control scans. Those with aortic ectasia (def.: 2.5-2.9 cm) were rescreened at 5-year intervals. AAA-operations and deaths of AAA at hospital were registered. Finally, costs of screening, surveillance, and treatment were registered. Data on causes of death outside hospitals could not be obtained.
The attendance rate was 76%, of whom 191 (4.0%) had AAA. The average observation time was 5.13 years. 60 in the screened and 41 in the control group were operated (P = 0.06), 7 and 27 were operated as an emergency (P < 0.001), and 6 and 19 died at the hospitals due to AAA (p = 0.009). The costs per scan were 83.50 DKK, 81,400 DKK per elective operation (71,485 DKK after screening), and 117,000 DKK for an emergency operation. The costs per prevented hospital death were 67,855 DKK or approx. 7,540 DKK per life year saved (1 GBP = 12 DKK).
Screening older males for AAA in Denmark seems very cost-effective and reduces hospital mortality of AAA by 68% and probably the overall AAA-specific mortality by 73%.
对老年男性进行腹主动脉瘤(AAA)筛查的医院成本和效益尚不清楚。
1994年,在丹麦维堡县启动了一项基于医院的筛查试验,对12658名65至73岁的男性进行筛查。直径大于5厘米的腹主动脉瘤患者被转诊接受手术。其余腹主动脉瘤患者每年接受对照扫描。主动脉扩张(定义为直径2.5至2.9厘米)的患者每5年重新筛查一次。记录腹主动脉瘤手术和在医院因腹主动脉瘤死亡的情况。最后,记录筛查、监测和治疗的费用。无法获取院外死亡原因的数据。
参与率为76%,其中191人(4.0%)患有腹主动脉瘤。平均观察时间为5.13年。筛查组有60人接受手术,对照组有41人接受手术(P = 0.06),7人在筛查组、27人在对照组进行了急诊手术(P < 0.001),6人在筛查组、19人在对照组因腹主动脉瘤在医院死亡(P = 0.009)。每次扫描费用为83.50丹麦克朗,择期手术每次费用为81400丹麦克朗(筛查后为71485丹麦克朗),急诊手术每次费用为117000丹麦克朗。预防医院死亡的成本为67855丹麦克朗,或每挽救一个生命年约7540丹麦克朗(1英镑 = 12丹麦克朗)。
在丹麦对老年男性进行腹主动脉瘤筛查似乎非常具有成本效益,可将腹主动脉瘤的医院死亡率降低68%,并可能将总体腹主动脉瘤特异性死亡率降低73%。