荷兰针对60至65岁男性腹主动脉瘤的大规模筛查。使用马尔可夫模型对预期寿命和成本效益的影响。

Mass screening on abdominal aortic aneurysm in men aged 60 to 65 years in The Netherlands. Impact on life expectancy and cost-effectiveness using a Markov model.

作者信息

Boll A P M, Severens J L, Verbeek A L M, van der Vliet J A

机构信息

Department of Surgery, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands.

出版信息

Eur J Vasc Endovasc Surg. 2003 Jul;26(1):74-80. doi: 10.1053/ejvs.2002.1773.

DOI:10.1053/ejvs.2002.1773

PMID:12819652

Abstract

OBJECTIVES

To predict the costs and effects on life expectancy of an AAA screening programme.

METHODS

A Markov model was designed to compare the effects of a single screening for a cohort of men 60-65 years with the current no screening strategy. The following health states were distinguished: no AAA, unknown small AAA, follow-up small AAA, unknown large AAA, repaired AAA, rejected large AAA and death. Transition rates between the health states were simulated using cycle times of one year. Transition probabilities were derived from literature and a previous feasibility study. Incremental costs per life year saved were calculated. Sensitivity analyses and discounting for future effects were performed.

RESULTS

The expected individual AAA costs for non-screening and AAA screening were euro; 196 and euro; 530 respectively. A difference of 3.5 months life expectancy was found in favour of screening leading to euro; 1176/life-year gained. Costs increased as compliance fell. With a discount rate of 4% the costs are euro; 2021/life-year gained.

CONCLUSIONS

One-time ultrasonographic screening for AAA in men aged 60-65 years appears to be cost-effective.

摘要

目的

预测腹主动脉瘤（AAA）筛查项目的成本及其对预期寿命的影响。

方法

设计了一个马尔可夫模型，以比较对60 - 65岁男性队列进行一次筛查与当前不筛查策略的效果。区分了以下健康状态：无AAA、小AAA情况未知、随访中的小AAA、大AAA情况未知、已修复的AAA、大AAA修复被拒以及死亡。使用一年的周期时间模拟健康状态之间的转换率。转换概率来自文献和先前一项可行性研究。计算了每挽救一个生命年的增量成本。进行了敏感性分析以及对未来影响的贴现。