| Key Question | Author (Year) and Overall Quality | Model Type Perspective | Data Source | Utility | Discount Rate | Screening Costs | Treatment Costs | Outcomes | ICER (2003 U.S.$) | Sensitivity Analysis (2003 U.S.$) | Comments |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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) Fair |
Decision model
Health system |
Systematic review by Canadian Task Force on the Periodic Health Examination; MEDLINE®, article bibliographies | None | 5% | $260 U/S | $46K elective; $90K ER | ICER | $72K/LY, one-time U/S; $1.5M/LY, U/S 5 yrs after first screen; $50K/LY, physical exam + U/S for positives; $1.3M/LY, additional U/S at 5 yrs | Effect of changes in individual parameter estimates not known (parameter values varied simultaneously between best and worst estimates) | Not societal perspective; no quality adjustments; effectiveness data > 11 yrs old (much lower LYS estimate than other studies); uninformative sensitivity analysis; quality of cost data uncertain; assumes no relative mortality risk for surgery survivors. |
| Lee, et al. (2002) Fair |
Markov Health system |
Probabilities, costs, and quality adjustments: literature review and New York Presbyterian Hospital | Renal failure, 0.68; stroke, 0.40; major amputation, 0.80; MI, 0.80 | 3% | $350 | Elective surgery, $22K; ruptured AAA, $39K; L/T cost of renal failure, stroke, MI, amputation included | ICER | $14K/QALY | Influential (univariate), age (screening after 83 inefficient) | Not societal perspective; quality of effectiveness and cost data uncertain; single-hospital source of cost data | |
| MASS (2002) Good |
Trial-based Health system |
MASS trial | Assumes 0.8 for UK elderly men | LY 1.5%; costs 6% | $1.58M total | Pre-operative consult, $433K; $4.26K, elective ($14K per); $516K, ER ($22K per) | ICER | 4 yrs $57K/LY; $72K/QALY; 10 yrs $16K/LY | Influential: all-cause mortality ($26K/LY) | Micro-costed interventions; effectiveness, reduction in AAA-related mortality up to 4 yrs; 10-yr horizon in sensitivity analysis; use of acceptability curves in sensitivity analysis | |
| 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) Fair |
See detail in Key Question 1 | |||||||||
| Soisalon- Soininen,
et al. (2001) Fair |
Decision model
Health system |
Screening probabilities: sample of first-degree relatives of 150 surgery patients at Helsinki University Central Hospital (HUCH); effectiveness and costs: Finnish Hospital Discharge Register and survival analysis of 1,150 surgery HUCH patients | None | 5% | $1M, total first screening; $261K total follow-up screenings | $6M | ICER | $8,900/LY, screening for male relatives | No influential variables in univariate analyses | Not societal perspective; no health state utilities; all data based on Finnish experience; generalizability of effectiveness and cost data uncertain | |
| 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) Good |
See detail in Key Question 1 | |||||||||
Notes: ER, emergency repair; ICER, incremental cost-effectiveness ratio; K, thousand; L/T, lifetime; LY, life year; LYS, life years saved; M, million; MI, myocardial infarction; QALY, quality-adjusted life-year; UK, United Kingdom; U/S, ultrasound; yrs, years.