Screening for Abdominal Aortic Aneurysm in a Modern Context and Issues for the Future

Abstract

In this issue, Svensjo et al. provide a topical review of screening for abdominal aortic aneurysms (AAAs). Review articles serve an important purpose in synthesizing knowledge, and, when conducted using a systematic approach including quality assessment, they qualify as the highest level evidence. However this is not the case for a topical review, which may instead have a role in highlighting noteworthy or controversial issues that are evolving in areas where research moves at a fast pace. In the AAA screening context, issues of such a kind include, for example, prevalence. Svensjo et al. conclude that falling prevalence may eradicate the cost-effectiveness of screening, but this has already been demonstrated to have an inferior impact in Sweden, the UK and Denmark. For the latter, it has been showed that halving the prevalence (from 3.3% to 1.6%) reduced the probability of screening being cost-effective by only one percentage point (from 92.0% to 91.0%). Other relevant aspects of a modern epidemiology concern increased incidental detection rate, use of endovascular repair, reduced risk of surgical repair, increased general cardiovascular prevention, and improved survival of aneurysm patients, among others. Cost-effectiveness is the major question in many countries that have not implemented screening programmes. AAA probably acts similarly across borders, whereas prevalence, healthcare protocols, costs, and culture probably differ. Ideally, a health economic model should therefore be established for every context, building on parameter estimates that hold validity for that particular context in order to appropriately support decision making. As a second best, existing studies can be reviewed but this should then be accompanied by a formal quality assessment in order to identify the validity of parameters and assumptions made