Screening for AAA Among Older Men Most Cost-Effective if Done Twice

It is most cost-effective to screen men over the age of 65 years for abdominal aortic aneurysm (AAA) twice, at five year intervals than to not screen them at all, say researchers from Denmark in a study published in the July 6 issue of BMJ.

Using a hypothetical population of 100,000 men aged 65 years, the researchers examined the expected lifetime costs and benefits of four AAA screening strategies: no screening, once per lifetime screening, twice per lifetime with a five-year interval, and continued screening every five years. Screening for AAA is usually done by ultrasound.

The number of elective surgeries that would result from the screening was compared with what the number of acute surgeries would be. Using the prediction model, the number of elective surgeries would increase from 861 to 1,390 per 100,000 if the men were screened once. For those screened twice, the number rose to 1,496, and for multiple screenings, it rose to 1,530
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The acute surgeries saw a decline: 382 from 610 among the once-only screenings, 363 for those with two screenings, and 360 for those with repeated screenings over life.

The rate of aneurysm mortality was reduced to 538 from 788 among the once-only screenings, 520 for those screened twice and 511 for lifetime screenings. This occurred because of the ability to perform elective surgery more often, preventing acute situations. 

“Screening seems to be highly cost effective compared with not screening,” the authors wrote. “If men with an aortic diameter of 25-29 mm at the initial screening were rescreened once after five years, 452 men per 100,000 initially screened would benefit from early detection, whereas lifetime screening every five years would detect 794 men per 100,000.”