AAA screening concept gains ground but faces funding challenge

We've known for some time that abdominal aortic aneurysm screening has great potential to save lives among our growing middle-aged and elderly populations. The Society for Interventional Radiology, which added ultrasound AAA screening to its Legs For Life program in 2000, reported last year that it has screened nearly 46,000 individuals and that the results prompted 11% of them to have a medical procedure or see their doctor. Ultrasound has a sensitivity of 95% and a specificity of 100% in detecting AAA.

Thus, the recommendation by the U.S. Preventive Services Task Force in February that male smokers and former smokers aged 65 to 75 be given AAA screening exams was welcome news (see article, page 11). AAA accounts for 15,000 deaths annually, making it the 17th leading cause of death in the U.S. It affects an estimated 5% to 7% of individuals 60 and older, a group that represents nearly 2.7 million people, according to 2000 census data.

The task force recommendation has been a long time coming, however. When the task force last visited the screening issue in 1996, it concluded that it had no basis to recommend for or against AAA screening for asymptomatic adults. That same year, a published study from the U.K. concluded that screening that identifies AAA equal to or greater than 6 cm compares favorably in quality-adjusted life-years gained to services such as breast and cervical cancer screening (Eur J Vasc Endovasc Surg 1996;11[2]:183-190).

Population-based studies conducted since 1996 cleared the way for the new task force recommendation. But even now, the recommendation is relatively restrictive. In addition to male ever-smokers aged 65 to 75, SIR suggests screening for men and women with a family history of AAA. The Society for Vascular Surgery recommends screening for all men aged 60 to 85, women aged 60 to 85 with cardiovascular risk factors, and all people aged 50 or older with a family history of AAA. In the U.K., a pilot program to screen men 65 and older produced favorable results, and a national screening program is being considered for all men 60 and older.

The SIR screening program, with no age restrictions, found one in four participants to be at risk for AAA, and one in 20 already affected.

Unfortunately, the task force recommendation will probably set the benchmark as Congress considers a proposal to add AAA screening to those procedures covered by Medicare. Private payers who could cover screening for pre-Medicare patients will be similarly influenced.

As of this writing, no cost has been attached to the legislation to have Medicare cover AAA screening, but Congress and the Bush administration are feeling the consequences of their profligate ways, and getting new screening programs approved will be a challenge. For the foreseeable future, we can anticipate that all types of healthcare initiatives, even those that make sound economic sense, will have a tough time getting funded as Washington comes to grips with runaway federal budget deficits.

The good news is that the legislation, HR 827, has bipartisan support in both chambers of Congress and the backing of the National Aneurysm Alliance, a coalition of medical professionals, patient advocates, and medical vendors. The bill has been introduced in the House as the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act.

You can learn more about the legislation at the Aneurysm Alliance Web site, screenaaa.org. Please also consider contacting your representatives in Congress or in other ways joining the effort to push for its approval. We know that AAA screening can lead to therapy that saves lives. Approving Medicare reimbursement for it is a major step in that direction.

What are your thoughts on this topic? Please e-mail me at jhayes@cmp.com.