Commentary on ‘Cost-effectiveness of Screening for Abdominal Aortic Aneurysm in Combination with Medical Intervention in Patients with Small Aneurysms’

Abstract

The multi-specialty Malmo group has performed a thorough analysis of cost efficiency in screening for abdominal aortic aneurysms (AAA), despite there being a lower incidence now than 20 years ago. This lower prevalence is not equally distributed worldwide, with a faster decline in well developed countries. As a true cost analysis would take a long time to perform, in addition to being cost intensive, the authors used the Markov model with different assumptions. In their nearly 80% attendance rate, which seems to also apply to other regions in Sweden, 0.14% of attendees had an AAA with a diameter of >5.5 cm and 0.21% had AAAs with diameters of 4.5e5.4 cm, 43% of which increased in diameter to>5.5 cm within one year. However, the authors still found it worthwhile, in their economic environment, to perform screening, as the price for a gained quality adjusted life year (QALY) was about V16,000. This sum is well below the accepted V50,000 for a QALY in some European countries (e.g., the UK, The Netherlands), even when used for other diagnoses and being age dependent. In order to consider the data in regard to a wider geographical application, four major factors could be considered: (i) attendance rate; (ii) cost of ultrasound; (iii) cost of operation; and (iv) prevalence of the AAA. Withregardto(i),theattendancerateforscreening(including other diagnoses such as breast, colonic, and prostate cancer) seemstodifferbetweencountries,withlowerattendancerates, for example, in Germany (w50%) and Italy (55e60%) but The Netherlands reports 83% and England 75e80% attendance. According toWanhainen’s group, though, the attendance rate had little effect on the cost effectiveness ratio in women. Considering point (ii), the cost of ultrasound also differs between different countries, especially the personnel costs. Thus, in some countries this cost may be much lower than that in Malmo (V90) but higher than in others. With regard to (iii), the sameargumentsmay beused for the cost of operation, where several countries’ surgical costs are