Screening for abdominal aortic aneurysm in men ages 60 to 80 years. A cost-effectiveness analysis.

PURPOSE

To evaluate the cost-effectiveness of screening by physical examination or abdominal ultrasonography for abdominal aortic aneurysm (AAA) in men aged 60 to 80 years.

DATA SOURCES

A systematic review of the pertinent literature by the Canadian Task Force on the Periodic Health Examination, augmented by an additional computerized search (MEDLINE) and references identified from bibliographies of pertinent articles. Several experts reviewed the data for completeness.

STUDY SELECTION

Published English-language studies that present data relevant to screening for abdominal aortic aneurysm.

DATA EXTRACTION

Several reviewers determined a range of data and the most probable value for each parameter.

DATA SYNTHESIS

A computer spreadsheet model was constructed to simulate the costs and effectiveness of various screening protocols in a cohort of 10,000 men during a period of 20 years. The primary cost-effectiveness measure computed was incremental present-value dollar expenditures for screening and treatment per incremental present-value life-year saved by the screening program. Using the "most probable" values for the simulation parameters, a single screening procedure of abdominal palpation followed by abdominal ultrasound scan for patients with positive screening results is estimated to gain 20 life-years at a cost of $28,741 per life-year. A single ultrasound screen gains 57 life-years at a cost of $41,550 per life-year. A repeated ultrasound screen after 5 years gains 1 additional life-year at a cost of $906,769.

CONCLUSIONS

A single screen for AAA by abdominal palpation in men from age 60 to 80 years might be considered cost-effective but of small benefit. A single screen with ultrasonography is at the high end of the cost-per-life-year range that might be considered cost-effective and also is of modest benefit. Repeated screening is not cost-effective.