Sweeting MJ, et al. - A third of deaths in the UK due to a ruptured abdominal aortic aneurysm (AAA) are in women, while national screening programs are cost-effective and decrease AAA deaths in men, so researchers explored the benefits, harms, and cost-effectiveness of screening women for AAA. Results of this study suggested that an AAA screening program for women, even one designed to be similar to that used for men, was unlikely to be cost-effective by UK standards. Other screening options had more favorable cost-effectiveness, but could lead to more overdiagnosis and overtreatment.

Methods

• A decision model was developed to evaluate predefined outcomes of death caused by AAA, life years, quality-adjusted life years, costs, and the incremental cost-effectiveness ratio for a population of women invited to AAA screening vs a population who were not invited to screening.
• After that, a discrete event simulation model was set up for AAA screening, surveillance, and intervention.
• From sources, including systematic literature reviews, national registry or administrative databases, major AAA surgery trials, and UK National Health Service reference costs, relevant women-specific parameters were obtained.

Results

• The study results showed that AAA screening for women, as currently offered to UK men (at age 65 years, with an AAA diagnosis at an aortic diameter of ≥3.0 cm, and elective repair considered at ≥5.5cm) gave, over 30 years, an estimated incremental cost-effectiveness ratio of £30,000 (95% CI 12,000–87,000) per quality-adjusted life year gained, with 3,900 invitations to screening required to prevent one AAA-related death and an overdiagnosis rate of 33%.
• A modified option for women (screening at age 70 years, diagnosis at 2.5 cm and repair at 5.0 cm) was evaluated to have an incremental cost-effectiveness ratio of £23,000 (9500–71,000) per quality-adjusted life year and 1800 invitations to screening required to prevent one AAA-death, yet an overdiagnosis rate of 55%.
• Considerable uncertainty in the cost-effectiveness ratio, largely driven by uncertainty about AAA prevalence, the distribution of aortic sizes for women at different ages, and the impact of screening on quality of life was found.