Vascular Surgery Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Vascular Biology and Inflammation Laboratory, CIBER Cardiovascular, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain.
General Practitioner in Primary Care Team EAP Encants, Barcelona, Spain.
Ann Vasc Surg. 2021 May;73:429-437. doi: 10.1016/j.avsg.2020.11.042. Epub 2020 Dec 30.
Based on current evidence, one-time screening for abdominal aortic aneurysm (AAA) in men using ultrasound evaluation reduces mortality related to AAA rupture and is considered cost-effective, although all-cause mortality reduction still remains in question. In Spain, there is no population screening program for AAA, so the aim of our study was to perform a pilot population screening program in our area to assess feasibility and efficiency of an AAA screening program for men and women.
A population AAA screening pilot program was performed in a Barcelona area, including 400,000 inhabitants. According to inclusion criteria, 4,730 individuals aged 65 years at the moment of the trial were invited for screening (2,089 men and 2,641 women). Primary care doctors, trained in duplex ultrasound abdominal evaluations, performed an abdominal aortic measurement. Individuals with a previous diagnosis of AAA, limited life expectancy, or wrong contact data were excluded. Participation data, aortic diameters, AAA prevalence, and related cardiovascular risk factors were analyzed. The results were used in a cost-utility model to assess the efficiency of the screening program.
Participation was 50.3% in men and 44% in women. Eleven patients were excluded because of previously diagnosed AAA. Five new asymptomatic AAA were detected in 65-year-old men (0.5% prevalence), all being active smokers. When considering patients excluded for previous AAA diagnosis, the prevalence in 65-year-old men reached 1.4%. Global AAA prevalence in smoking men reached 2.67%. No AAA was detected in women. Subaneurysmal aorta prevalence in men was 2.9% (n = 29), and in women, it was 0.08% (n = 2). A cost-utility analysis model on screening versus no screening retrieved 13,664€ per quality-adjusted life years at a 10-year horizon and 39,455€ per quality-adjusted life years at a 30-year horizon.
AAA population-based screening by ultrasound evaluation in primary care is logistically feasible in our area. Despite that, AAA prevalence is lower than expected in men, and null in women. Cost-utility model results indicate that a local AAA screening program is only efficient in a 30 years' time horizon. Such inefficient results for a population screening make it necessary to consider other strategies such as opportunistic or subgroup screening in our area.
基于现有证据，使用超声评估对男性进行一次性腹主动脉瘤（AAA）筛查可降低AAA 破裂相关死亡率，且具有成本效益，尽管全因死亡率降低仍存在争议。在西班牙，尚无 AAA 人群筛查计划，因此，我们的研究旨在对本地区进行 AAA 人群筛查试点计划，以评估男性和女性 AAA 筛查计划的可行性和效率。
在巴塞罗那地区开展了一项 AAA 人群筛查试点计划，涵盖 40 万居民。根据纳入标准，共有 4730 名年龄在试验时为 65 岁的个体受邀进行筛查（2089 名男性和 2641 名女性）。接受过双功能超声腹部评估培训的初级保健医生进行了腹主动脉测量。既往诊断为 AAA、预期寿命有限或联系方式错误的个体被排除在外。分析了参与情况、主动脉直径、AAA 患病率和相关心血管危险因素。结果用于成本效益模型以评估筛查计划的效率。
男性的参与率为 50.3%，女性为 44%。11 名患者因先前诊断的 AAA 而被排除在外。在 65 岁的男性中发现了 5 例新的无症状性 AAA（0.5%的患病率），均为主动吸烟者。考虑到因先前诊断为 AAA 而被排除的患者，65 岁男性的患病率达到 1.4%。吸烟男性的全球 AAA 患病率达到 2.67%。未在女性中发现 AAA。男性亚AAA 患病率为 2.9%（n=29），女性为 0.08%（n=2）。在 10 年时间内，筛查与不筛查的成本效益分析模型得出每增加 1 个质量调整生命年需要 13664 欧元，在 30 年时间内则需要 39455 欧元。
在我们地区，通过初级保健进行基于人群的超声评估 AAA 筛查在后勤上是可行的。尽管如此，男性的 AAA 患病率低于预期，而女性则为零。成本效益模型结果表明，在 30 年内，当地的 AAA 筛查计划仅具有效率。这种针对人群筛查的低效率结果使得有必要在本地区考虑其他策略，如机会性或亚组筛查。
