Rescreening for Aneurysm Both Cost Effective and Beneficial

A research team in Denmark has found that screening men aged more than 65 years more than once for aneurysm is not just cost effective, but also advisable. This could prove highly beneficial for men who have a history of heart disease or have been long term smokers, the study published today in BMJ suggests.



One-off screening for men over the age of 65 is already an accepted method for diagnosing abdominal aortic aneurysms. It is not just effective but also cost effective. Some European countries including England and Scotland have a national screening programmes in place for this, but several other countries still lag far behind.



Men between the ages of 67 and 75, particularly those who are or have been smokers, are highly susceptible to abdominal aortic aneurysms, a condition in which the artery wall balloons. If the ballooning becomes extensive, the artery wall can rupture and result in death. However, aneurysms at risk of rupture can be diagnosed by screening and treated through a surgical procedure.



So far, such screening is only done once and rarely repeated. So the research team from Denmark, which does not have a national screening program, took up a study to check if there were any benefits to be had from different strategies for abdominal aortic aneurysms and if the same was cost effective. They took up a hypothetical population of 100,000 men over the age of 65 and set up a prediction model.



They used four different screening strategies with the population – no screening, a one-off screening, twice in a lifetime screening with a five year gap, and regular screening every five years for life. Their study confirmed that compared to no screening and even one-off screening, two time screening was much more cost effective for men who were at high risk of aneurysm rupture. These individuals had an aortic artery diameter of 25-29 mm.



In financial terms, the researchers found that for every 100,000 high risk individuals who were rescreened after five years, 452 additional patients were detected. The cost per quality adjusted life year (QALY) came to £10,013, which was within the defined limit of £20,000 set by the UK National Institute for Health and Clinical Excellence (NICE).



However, if rescreening every five years was carried on for lifetime, only 794 additional men per 100,000 were detected, but the cost shot up to £29,680 per QALY. The researchers estimated that the two rescreening strategies, wherein screening was repeated after five years and at on-going five-year intervals, would lead to an increase in elective operations to 1,496 and 1,530 per 100,000 respectively against 861 per 100,000.



On the opposite end of the spectrum, the researchers estimated that the number of acute emergency operations with rescreening could drop to 363 and 360 per 100,000 respectively against 610 per 100,000 with no screening. Similarly, deaths due to aneurysm dropped from 788 to 520 and 511 per 100,000 respectively.



The researchers opine that rescreening at least once is a lot more cost effective and beneficial that no screening at all. At the same time, they conclude that further research is required to determine the optimal rescreening method as well as establish its long term costs and benefits.

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