Cargando…
Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study
Objectives To assess whether the mortality benefit from screening men aged 65-74 for abdominal aortic aneurysm decreases over time, and to estimate the long term cost effectiveness of screening. Design Randomised trial with 10 years of follow-up. Setting Four centres in the UK. Screening and surveil...
Autores principales: | , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group Ltd.
2009
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272658/ https://www.ncbi.nlm.nih.gov/pubmed/19553269 http://dx.doi.org/10.1136/bmj.b2307 |
_version_ | 1782222821501435904 |
---|---|
author | Thompson, S G Ashton, H A Gao, L Scott, R A P |
author_facet | Thompson, S G Ashton, H A Gao, L Scott, R A P |
author_sort | Thompson, S G |
collection | PubMed |
description | Objectives To assess whether the mortality benefit from screening men aged 65-74 for abdominal aortic aneurysm decreases over time, and to estimate the long term cost effectiveness of screening. Design Randomised trial with 10 years of follow-up. Setting Four centres in the UK. Screening and surveillance was delivered mainly in primary care settings, with follow-up and surgery offered in hospitals. Participants Population based sample of 67 770 men aged 65-74. Interventions Participants were individually allocated to invitation to ultrasound screening (invited group) or to a control group not offered screening. Patients with an abdominal aortic aneurysm detected at screening underwent surveillance and were offered surgery if they met predefined criteria. Main outcome measures Mortality and costs related to abdominal aortic aneurysm, and cost per life year gained. Results Over 10 years 155 deaths related to abdominal aortic aneurysm (absolute risk 0.46%) occurred in the invited group and 296 (0.87%) in the control group (relative risk reduction 48%, 95% confidence interval 37% to 57%). The degree of benefit seen in earlier years of follow-up was maintained in later years. Based on the 10 year trial data, the incremental cost per man invited to screening was £100 (95% confidence interval £82 to £118), leading to an incremental cost effectiveness ratio of £7600 (£5100 to £13 000) per life year gained. However, the incidence of ruptured abdominal aortic aneurysms in those originally screened as normal increased noticeably after eight years. Conclusions The mortality benefit of screening men aged 65-74 for abdominal aortic aneurysm is maintained up to 10 years and cost effectiveness becomes more favourable over time. To maximise the benefit from a screening programme, emphasis should be placed on achieving a high initial rate of attendance and good adherence to clinical follow-up, preventing delays in undertaking surgery, and maintaining a low operative mortality after elective surgery. On the basis of current evidence, rescreening of those originally screened as normal is not justified. Trial registration Current Controlled Trials ISRCTN37381646. |
format | Online Article Text |
id | pubmed-3272658 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2009 |
publisher | BMJ Publishing Group Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-32726582012-02-16 Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study Thompson, S G Ashton, H A Gao, L Scott, R A P BMJ Research Objectives To assess whether the mortality benefit from screening men aged 65-74 for abdominal aortic aneurysm decreases over time, and to estimate the long term cost effectiveness of screening. Design Randomised trial with 10 years of follow-up. Setting Four centres in the UK. Screening and surveillance was delivered mainly in primary care settings, with follow-up and surgery offered in hospitals. Participants Population based sample of 67 770 men aged 65-74. Interventions Participants were individually allocated to invitation to ultrasound screening (invited group) or to a control group not offered screening. Patients with an abdominal aortic aneurysm detected at screening underwent surveillance and were offered surgery if they met predefined criteria. Main outcome measures Mortality and costs related to abdominal aortic aneurysm, and cost per life year gained. Results Over 10 years 155 deaths related to abdominal aortic aneurysm (absolute risk 0.46%) occurred in the invited group and 296 (0.87%) in the control group (relative risk reduction 48%, 95% confidence interval 37% to 57%). The degree of benefit seen in earlier years of follow-up was maintained in later years. Based on the 10 year trial data, the incremental cost per man invited to screening was £100 (95% confidence interval £82 to £118), leading to an incremental cost effectiveness ratio of £7600 (£5100 to £13 000) per life year gained. However, the incidence of ruptured abdominal aortic aneurysms in those originally screened as normal increased noticeably after eight years. Conclusions The mortality benefit of screening men aged 65-74 for abdominal aortic aneurysm is maintained up to 10 years and cost effectiveness becomes more favourable over time. To maximise the benefit from a screening programme, emphasis should be placed on achieving a high initial rate of attendance and good adherence to clinical follow-up, preventing delays in undertaking surgery, and maintaining a low operative mortality after elective surgery. On the basis of current evidence, rescreening of those originally screened as normal is not justified. Trial registration Current Controlled Trials ISRCTN37381646. BMJ Publishing Group Ltd. 2009-06-24 /pmc/articles/PMC3272658/ /pubmed/19553269 http://dx.doi.org/10.1136/bmj.b2307 Text en © Thompson et al 2009 http://creativecommons.org/licenses/by-nc/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Thompson, S G Ashton, H A Gao, L Scott, R A P Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study |
title | Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study |
title_full | Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study |
title_fullStr | Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study |
title_full_unstemmed | Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study |
title_short | Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study |
title_sort | screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised multicentre aneurysm screening study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272658/ https://www.ncbi.nlm.nih.gov/pubmed/19553269 http://dx.doi.org/10.1136/bmj.b2307 |
work_keys_str_mv | AT thompsonsg screeningmenforabdominalaorticaneurysm10yearmortalityandcosteffectivenessresultsfromtherandomisedmulticentreaneurysmscreeningstudy AT ashtonha screeningmenforabdominalaorticaneurysm10yearmortalityandcosteffectivenessresultsfromtherandomisedmulticentreaneurysmscreeningstudy AT gaol screeningmenforabdominalaorticaneurysm10yearmortalityandcosteffectivenessresultsfromtherandomisedmulticentreaneurysmscreeningstudy AT scottrap screeningmenforabdominalaorticaneurysm10yearmortalityandcosteffectivenessresultsfromtherandomisedmulticentreaneurysmscreeningstudy |