CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S3
DOI: 10.1055/s-0041-1730652

Abdominal Aortic Aneurysm Screening: A Systematic Review and Meta-Analysis of Efficacy and Cost

Andrew Ying
Westmead Hospital, Australia
Eshan Affan
Royal Prince Alfred Hospital, Sydney, Australia
› Author Affiliations

Background: Abdominal aortic aneurysms (AAAs) can cause significant mortality when ruptured but are often undiagnosed before this time. Population screening of high-risk individuals and early intervention may mitigate AAA-related mortality. Large trials have demonstrated a mortality benefit for AAA screening, but adoption is not ubiquitous. This study sought to systematically review and consolidate the most recent randomized trial evidence on AAA screening in men and its cost-effectiveness. Methods: Randomized trials and cost-effectiveness studies of AAA screening in men were identified from searching Medline, Embase, CENTRAL, and relevant citation lists. Data were extracted as hazard ratios or raw event rates. Meta-analysis was conducted using a random-effects, inverse variance weighted model for continuous variables and Mantel-Haenszel weighting for event data. Cost estimates of screening were adjusted for inflation and reported as $US/quality-adjusted life year (QALY). Results: Five studies were identified totaling 175,085 participants (age 64–83) with a mean of 10.6 years of follow-up (4.4–13.1). The AAA detection ranged from 3.3% to 7.7%. Screening significantly reduced all-cause mortality (hazard ratio: 0.97, 95% confidence interval [CI]: 0.96–0.99, P = 0.002), AAA-related mortality (0.65, 95% CI: 0.48–0.89, P = 0.008), and emergent AAA repair (RR: 0.64, 95% CI: 0.46–0.91, P = 0.02). The number needed to screen to prevent one AAA-related death per 10 years ranged from 209 to 769 individuals. Sixteen cost-effectiveness analyses found a mean 16,854 $/QALY (range 266–73,369). Conclusion: Wider implementation of population-based AAA screening programs in elderly men should be considered as it continues to demonstrate a significant and cost-effective reduction in all-cause mortality as well as AAA-related mortality.

Publication History

Article published online:
11 May 2021

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