Abdominal Aortic Aneurysm Screening: A Systematic Review and Meta-Analysis of Efficacy and Cost

Abstract

Background Abdominal aortic aneurysms (AAA) can cause significant mortality when ruptured but are often undiagnosed before this time. Population screening of high-risk individuals and early intervention may mitigate AAA-related mortality. Large trials have demonstrated a mortality benefit for AAA screening, but adoption is not ubiquitous. This study sought to systematically review and consolidate the most recent randomized trial evidence on AAA screening in men and its cost-effectiveness. Methods Randomized trials and cost-effectiveness analyses (CEAs) of AAA screening in men were identified from searching Medline, Embase, CENTRAL, and relevant citation lists. Data were extracted as hazard ratios or raw event rates. Meta-analysis was conducted using a random-effects, inverse variance weighted model for continuous variables and Mantel-Haenszel weighting for event data. Cost estimates of screening were adjusted for inflation and reported as $US/quality-adjusted life year. Results Five studies were identified totaling 175,085 participants (age, 64–83 years) with a mean 10.6 years of follow-up (4.4–13.1). The AAA detection ranged from 3.3 to 7.7%. Screening significantly reduced all-cause mortality (hazard ratio, 0.97; 95% confidence interval, 0.96–0.99; P = 0.002), AAA-related mortality (0.65; 95% confidence interval, 0.48–0.89; P = 0.008), and emergent AAA repair (relative risk, 0.64; 95% confidence interval, 0.46–0.91; P = 0.02). The number needed to screen to prevent 1 AAA-related death per 10 years ranged from 209 to 769 individuals. Sixteen CEAs found a mean 16,854 $/QALY (range, 266–73,369). Conclusions Wider implementation of population-based AAA screening programs in elderly men should be considered as it demonstrates a significant and cost-effective reduction in all-cause mortality as well as AAA-related mortality.