| Key Question |
Author (Year) |
Intervention |
Interval |
Time Horizon |
Baseline Group |
AAA Size |
AAA Prevalence |
Annual Rupture Rate |
% Ruptures Surviving to Surgery |
Elective Operative Mortality |
Emergency Operative Mortality |
| 1. Compared with usual care—i.e., no screening— what is the cost-effectiveness of population-based screening
of asymptomatic adults for AAA to reduce the risk for abdominal aortic rupture and AAA-specific
morbidity and mortality? |
Frame, et al. (1993) |
AAA screening by physical exam or U/S in males aged 60-80 |
One-time, repeated after 5 yrs |
20 yrs |
Hypothetical cohort of 10,000 males aged 60-79 |
4.0 cm, referral to surgery | 3.1% < 4.0 cm;
2.3% > 4.0 cm | 4% > 4.0 cm;
9% < 4.0 cm | 38% | 5% | 50% |
| Lee, et al. (2002) |
Quick-screen U/S
vs full screen |
NA |
Lifetime |
Hypothetical 70 yr old males |
3.0-5.0 cm, surveillance 5.0 cm, referral to
surgery | 7% | 0.1% 3.0 cm;
0.6% 3.0-4.0 cm;
2.3% 4.0-5.0 cm;
7% > 5.0 cm | 56% | 4% | 49% |
| MASS (2002) |
Trial-based CEA of
U/S screening vs no
screening |
3.0-4.4 cm, annual;
4.5-5.4 cm,
quarterly |
4 yrs and
10 yrs |
Population-based
sample of 67,800
UK males aged
65-74 |
5.5 cm, symptoms
or rapid expansion
referred to surgery | 5.5% | 0.04% invitees;
0.08% controls | 40% for invitees;
40% for controls | 6% | 37% |
| 2. What is the cost-effectiveness of selectively screening adults at higher risk for rupture—e.g., those with a
family history of AAA, peripheral vascular disease, and tobacco use—compared with routine screening
and usual care? |
Lee, et al. (2002) |
See detail in Key Question 1 |
| Soisalon-Soininen,
et al. (2001) |
Screening of first-degree male
relatives > 50 of
AAA patients vs no
screening |
6 mo (3.0-4.0 cm);
Annual (2.1-2.9 cm) |
Lifetime (17 yrs) |
First-degree male
relatives (aged > 50)
of 150 consecutive
AAA pts |
5.0 cm, referred to surgery | 8.2% among
relatives | 0% > 5.0 cm;
5% > 5.0 cm | 13% | 4% | 64% |
| 3. Among individuals with 3.0 to 5.4 cm AAAs on initial screening exam, what is the cost-effectiveness of periodic surveillance compared with one-time screening? |
NA |
| 4. Among individuals without AAA on initial screening exam, what is the cost-effectiveness of re-screening at varying intervals compared with one-time screening? |
NA |
| 5. How will differences in treatment effectiveness affect cost-effectiveness estimates for AAA screening? |
MASS (2002) |
See detail in Key Question 1 |
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