Aneurysm screening for men aged over 65 is cost effective and rescreening those at highest risk, at least once, should be considered, suggests a study published on bmj.com today.
Abdominal aortic aneurysms (caused by ballooning of the artery wall) usually occur in men aged between 65 and 75 years old and are more common among smokers. If the artery wall ruptures, the risk of death is high, but aneurysms at risk of rupture can be detected by screening and surgically repaired.
One-off screening for men aged over 65 is known to be cost effective and national screening programmes are currently being implemented in England and Scotland. But many other European countries have not yet issued guidance on screening.
So a team of researchers in Denmark, where national screening has not yet been implemented, set out to assess the benefits and cost effectiveness of different strategies for abdominal aortic aneurysm screening.
They used a prediction model with a hypothetical population of 100,000 men aged 65 years to test four different screening strategies: no screening; once per lifetime screening; twice per lifetime screening with a 5-year interval; and lifetime screening every five years.
Their results confirm that screening is highly cost effective compared with no screening and suggest that rescreening individuals with a high rupture risk (aortic artery diameter 25-29 mm) at least once more during their lifetime may be the most cost effective option.
For example, if high risk individuals were rescreened once after five years, an additional 452 per 100,000 would be detected and it would cost -10,013 per quality adjusted life year (QALY) - well within the cost effectiveness threshold of -20,000 set by the UK National Institute for Health and Clinical Excellence (NICE).
In contrast, lifetime rescreening every five years would detect an additional 794 men per 100,000 but would cost -29,680 per QALY.