St Leger A S, Spencely M, McCollum C N, Mossa M
School of Epidemiology and Health Sciences, University of Manchester, UK.
Eur J Vasc Endovasc Surg. 1996 Feb;11(2):183-90. doi: 10.1016/s1078-5884(96)80049-9.
To evaluate the effects of introducing routine ultrasonic screening for the identification and elective surgical treatment of abdominal aortic aneurysms (AAA) at high risk of rupture in the U.K. population of men aged 65-74 years.
A computer assisted simulation of an AAA screening programme. The simulation incorporated assumptions gleaned from the literature about the epidemiology of AAA and the costs of screening. In addition, up-to-date costings based on recent Manchester (U.K.) vascular surgery experience are used.
A dialogue between National Health Service commissioners and providers to explore the feasibility and desirability of introducing AAA screening. CHIEF OUTCOME MEASURE: Cost per quality adjusted life year (QALY) gained.
The absolute cost (circa 1992/3) per QALY gained from screening for and treating aneurysms of > or = 6 cm in diameter of pounds 1500 (benefit not discounted). Offsetting current treatment costs of ruptured aneurysms gives a net additional cost per QALY of pounds 1300. Screening and treating aneurysms of > or = 5 cm leads to a cost per QALY gained exceeding pounds 20000. The findings are robust under sensitivity analysis.
Routine screening for AAAs of size > or = 6 cm compares favourably in terms of cost per QALY gained with services such as breast and cervical cancer screening.
评估在英国65 - 74岁男性人群中引入常规超声筛查以识别和选择性手术治疗有破裂高风险的腹主动脉瘤（AAA）的效果。
对AAA筛查项目进行计算机辅助模拟。该模拟纳入了从文献中收集的关于AAA流行病学和筛查成本的假设。此外，还使用了基于英国曼彻斯特近期血管外科手术经验的最新成本核算。
英国国家医疗服务体系的医疗服务购买方与医疗服务提供方之间的对话，以探讨引入AAA筛查的可行性和可取性。主要结局指标：每获得一个质量调整生命年（QALY）的成本。
对直径≥6 cm的动脉瘤进行筛查和治疗，每获得一个QALY的绝对成本（约1992/3年）为1500英镑（效益未折现）。抵消当前破裂动脉瘤的治疗成本后，每获得一个QALY的净额外成本为1300英镑。对直径≥5 cm的动脉瘤进行筛查和治疗，每获得一个QALY的成本超过20000英镑。在敏感性分析下，研究结果具有稳健性。
就每获得一个QALY的成本而言，对直径≥6 cm的AAA进行常规筛查与乳腺癌和宫颈癌筛查等服务相比具有优势。
