Key result
One-time AAA ultrasound screening cuts AAA-related deaths ~85% and is highly cost-effective.
Why the study?
Screening programs for abdominal aortic aneurysm are not available in Canada, leaving their effectiveness and cost-utility in Ontario unknown.
Does one-time ultrasonography-based AAA screening reduce AAA-related deaths and improve cost-utility in people aged 65 years?
Does one-time ultrasonography-based AAA screening reduce AAA-related deaths and improve cost-utility in people aged 65 years?
Absolute Risk Reduction: 0.45
Absolute Event Rate: 0.08% vs 0.53%
Absolute Risk Reduction: 0.45%
Number Needed to Treat: 222
One-time ultrasonography screening for AAA in 65-year-olds in Ontario is associated with fewer AAA-related deaths and is highly cost-effective for both males and females.
May support one-time AAA screening at age 65; extends Canadian cost-effectiveness modeling but leaves generalizability and practice change open.
BACKGROUND: Screening programs for abdominal aortic aneurysm (AAA) are not available in Canada. We sought to determine the effectiveness and costutility of AAA screening in Ontario. METHODS: We compared one-time ultrasonography-based AAA screening for people aged 65 years to no screening using a fully probabilistic Markov model with a lifetime horizon. We estimated life-years, quality-adjusted life-years (QALYs), AAA-related deaths, number needed to screen to prevent 1 AAA-related death and costs (in Canadian dollars) from the perspective of the Ontario Ministry of Health. We retrieved model inputs from literature, Statistics Canada, and the Ontario Case Costing Initiative. RESULTS: Screening reduced AAA-related deaths by 84.9% among males and 81.0% among females. Compared with no screening, screening resulted in 0.04 (18.96 v. 18.92) additional life-years and 0.04 (14.95 v. 14.91) additional QALYs at an incremental cost of $80 per person among males. Among females, screening resulted in 0.02 (21.25 v. 21.23) additional life-years and 0.01 (16.20 v. 16.19) additional QALYs at an incremental cost of $11 per person. At a willingness-to-pay of $50 000 per year, screening was cost-effective in 84% (males) and 90% (females) of model iterations. Screening was increasingly cost-effective with higher AAA prevalence. INTERPRETATION: Screening for AAA among people aged 65 years in Ontario was associated with fewer AAA-related deaths and favourable cost-effectiveness. To maximize QALY gains per dollar spent and AAA-related deaths prevented, AAA screening programs should be designed to ensure that populations with high prevalence of AAA participate.
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Vervoort et al. (2024) studied Abdominal aortic aneurysm (n=1,000). One-time ultrasonography-based AAA screening vs. No screening was evaluated on AAA-related deaths (males aged 65 years) (ARR 0.45%). One-time ultrasonography screening for abdominal aortic aneurysm among 65-year-olds in Ontario reduced AAA-related deaths by 84.9% in males and 81.0% in females, and was highly cost-effective.
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