O-012 - EVALUATING THE COST-EFFECTIVENESS OF AAA SCREENING IN HIGH-RISK WOMEN

TOPIC:
Abdominal Aortic Aneurysms
AUTHORS:
Narouz M. (Imperial College London ~ London ~ United Kingdom) , Aslam M. (Imperial College London ~ London ~ United Kingdom)
Introduction:
Abdominal aortic aneurysms (AAAs), prevalent in 4-8% of males, may rupture suddenly with a mortality rate of up to 90%. Accordingly, the UK national screening programme offers AAA screening for men aged ≥65 years, particularly those with a family or smoking history. This programme has been shown to be cost-effective even if the prevalence was to drop to 0.35%. A cost-effective intervention is defined by NICE as one with an incremental cost-effectiveness ratio (ICER) <£20,000/QALY. Women are not included in the programme due to their lower AAA prevalence. Recent research has demonstrated an AAA prevalence of over 1% and 2% in females aged ≥70 and current smokers aged ≥60, respectively, with a rupture rate almost quadruple that of men. Therefore, logic follows that it would be cost-effective to screen women also but, the evidence remains unclear. This study assessed whether AAA screening in high-risk females; those aged ≥70 years and/or those aged ≥60 with a history of smoking, would be cost-effective.
Methods:
Two Markov cohort simulation models were built, using data extracted from the literature to build the model parameters. The ICER of each model was calculated and one-way sensitivity analysis was subsequently performed to assess the reliability of the model throughout variation of the parameters.
Results:
Screening women aged ≥70 produced an ICER of £4188.76/QALY and screening ever-smokers aged ≥60 produced an ICER of £2495.22/QALY. One-way sensitivity analysis revealed the model was insensitive to a change in the parameters, with the unsurprising exception of risk of AAA rupture if unscreened.
Conclusion:
It is cost-effective to screen females as young as 60 for AAAs, particularly those with a history of smoking. Both models support the hypothesis that screening women is also cost-effective. With extremely limited clinical trials thus far, screening for AAAs in females has long been a neglected field and further studies should investigate whether these results, indeed, translate clinically. Despite the limitations of the model's assumptions, in light of this study and other recent meta-analyses, governing bodies must consider screening women.