Swedish Abdominal Aortic Aneurysm Screening Program
What is the outcome of a general abdominal aortic aneurysm (AAA) screening program, targeting 65-year-old men?
Data on number of invited and examined men, screening-detected AAAs, AAAs operated on, and surgical outcome were retrieved from all 21 Swedish counties for the years 2006-2014. AAA-specific mortality data were retrieved from the Swedish Cause of Death Registry. A linear regression analysis was used to estimate the effect on AAA-specific mortality among all men ≥65 years for the observed time period. The long-term effects were projected using a validated Markov model.
Of 302,957 men aged 65 years invited, 84% attended. The prevalence of screening-detected AAA was 1.5%. After a mean of 4.5 years, 29% of patients with AAA had been operated on, with a 30-day mortality rate of 0.9% (1.3% after open repair and 0.3% after endovascular repair, p < 0.001). The introduction of screening was associated with a significant reduction in AAA-specific mortality (mean 4.0% per year of screening, p = 0.020). The number needed to screen and the number needed to operate on to prevent one premature death were 667 and 1.5, respectively. With a total population of 9.5 million, the Swedish national AAA screening program was predicted to annually prevent 90 premature deaths from AAA, and to gain 577 quality-adjusted life-years (QALYs). The incremental cost-efficiency ratio was estimated to be €7770 per QALY.
The authors concluded that screening 65-year-old men for AAA is an effective preventive health measure, and is highly cost-effective in a contemporary setting.
This study reports that a population-based AAA screening program can be implemented in a simple way, at low cost, and that is well accepted by the population. These contemporary real-world data further suggest that one-time screening of 65-year-old men for AAA is an effective preventive health measure, and highly cost-effective. These findings confirm results from earlier randomized controlled trials and model studies in a large population-based setting, and may have implications for future health care decision making.
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