Kim Lois G, P Scott R Alan, Ashton Hilary A, Thompson Simon G
Institute of Public Health, Cambridge, United Kingdom, and St. Richard's Hospital, Chichester, United Kingdom.
Ann Intern Med. 2007 May 15;146(10):699-706. doi: 10.7326/0003-4819-146-10-200705150-00003.
Longer-term mortality benefit and cost-effectiveness for abdominal aortic aneurysm (AAA) screening are uncertain.
To estimate the benefits, in terms of AAA-related and all-cause mortality, and cost-effectiveness of ultrasonography screening for AAA in a group that was invited to screening compared with a group that was not invited at a mean 7-year follow-up.
Randomized trial.
4 centers in the United Kingdom.
Population-based sample of 67,770 men age 65 to 74 years.
Patients with an AAA detected at screening had surveillance and were offered surgery after predefined criteria were met.
Mortality data were obtained after flagging on the national database. Unit costs obtained from large samples were applied to individual event data for the cost analysis.
The hazard ratio was 0.53 (95% CI, 0.42 to 0.68) for AAA-related mortality in the group invited for screening. The rupture rate in men with normal results on initial ultrasonography has remained low: 0.54 rupture (CI, 0.25 to 1.02 ruptures) per 10 000 person-years. In terms of all-cause mortality, the observed hazard ratio was 0.96 (CI, 0.93 to 1.00). At the 7-year follow-up, cost-effectiveness was estimated at $19 500 (CI, $12,400 to $39,800) per life-year gained based on AAA-related mortality and $7600 (CI, $3300 to infinity) per life-year gained based on all-cause death. (All values are reported in U.S. dollars [U.K. 1 pound sterling = U.S. $1.58]).
Inclusion of deaths from aortic aneurysm at an unspecified site, which may include some thoracic aortic aneurysms, may have underestimated the treatment effect.
These results from a large, pragmatic randomized trial show that the early mortality benefit of screening ultrasonography for AAA is maintained in the longer term and that the cost-effectiveness of screening improves over time. International Standard Randomized Controlled Trial registration number: ISRCTN37381646.
腹主动脉瘤（AAA）筛查的长期死亡率获益和成本效益尚不确定。
在平均7年的随访中，评估在受邀参加筛查的人群中，与未受邀人群相比，超声筛查AAA在AAA相关死亡率和全因死亡率方面的获益以及成本效益。
随机试验。
英国的4个中心。
基于人群的67770名65至74岁男性样本。
筛查中检测出AAA的患者接受监测，并在符合预定义标准后接受手术。
在国家数据库标记后获取死亡率数据。从大样本中获得的单位成本应用于个体事件数据进行成本分析。
受邀参加筛查组的AAA相关死亡率的风险比为0.53（95%CI，0.42至0.68）。初次超声检查结果正常的男性破裂率一直较低：每10000人年0.54例破裂（CI，0.25至1.02例破裂）。就全因死亡率而言，观察到的风险比为0.96（CI，0.93至1.00）。在7年随访时，基于AAA相关死亡率，估计每获得一个生命年的成本效益为19500美元（CI，12400至39800美元），基于全因死亡，每获得一个生命年的成本效益为7600美元（CI，3300至无穷大）。（所有数值均以美元报告[1英镑=1.58美元]）。
纳入未明确部位的主动脉瘤死亡病例，其中可能包括一些胸主动脉瘤，可能低估了治疗效果。
这项大型实用随机试验的结果表明，AAA筛查超声检查的早期死亡率获益在长期内得以维持，且筛查的成本效益随时间推移而提高。国际标准随机对照试验注册号：ISRCTN37381646。
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