Cost-effectiveness of targeted screening for abdominal aortic aneurysm in siblings

Abstract

Abstract Background Population screening for abdominal aortic aneurysm (AAA) in 65-year-old men has been shown to be cost-effective. A risk group with higher prevalence is siblings of patients with an AAA. This health economic model-based study evaluated the potential cost-effectiveness of targeted AAA screening of siblings. Methods A Markov model validated against other screening programmes was used. Two methods of identifying siblings were analysed: direct questioning of patients with an AAA (method A), and employing a national multigeneration register (method B). The prevalence was based on observed ultrasound data on AAAs in siblings. Additional parameters were extracted from RCTs, vascular registers, literature and ongoing screening. The outcome was cost-effectiveness, probability of cost-effectiveness at different willingness-to-pay (WTP) thresholds, reduction in AAA death, quality-adjusted life-years (QALYs) gained and total costs on a national scale. Results Methods A and B were estimated to reduce mortality from AAA, at incremental cost-effectiveness ratios of €7800 (95 per cent c.i. 4627 to 12 982) and €7666 (5000 to 13 373) per QALY respectively. The probability of cost-effectiveness was 99 per cent at a WTP of €23 000. The absolute risk reduction in AAA deaths was five per 1000 invited. QALYs gained were 27 per 1000 invited. In a population of ten million, methods A and B were estimated to prevent 12 and 17 AAA deaths, among 2418 and 3572 siblings identified annually, at total costs of €499 500 and €728 700 respectively. Conclusion The analysis indicates that aneurysm-related mortality could be decreased cost-effectively by applying a targeted screening method for siblings of patients with an AAA.