| 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 |
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