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Question clinique
Is screening for abdominal aortic aneurysm in women effective in decreasing mortality—and is it cost-effective?
L’Essentiel
In this analysis, screening women for abdominal aortic aneurysm (AAA) is not very effective. It is also not cost-effective by British standards, but appears to be borderline cost-effective by US standards (less than $40,000 per quality-adjusted life year). 1b
Référence
Plan de l'etude: Cost-effectiveness analysis
Financement: Government
Cadre: Population-based
Sommaire
These authors used a Markov decision analysis as the framework for conducting a cost-effectiveness analysis of screening women for AAA. A Markov analysis models how outcomes change over time. They adapted a previously validated analytic structure for screening men. They used data from published literature, hospital databases, and registries to gather such information as the frequency of prevalence of AAA at various ages, rupture rates by AAA size, surgical effectiveness, and so forth. Because these data may not reflect the "truth," the authors performed sensitivity analyses to determine thresholds at which the data would change the "final answer." The authors' synthesis suggests that screening women starting at age 65 years, using 3 cm as a diagnostic cutoff, and 5.5 cm as the cutoff for surgery would detect 0.31% of AAAs in the population (roughly 25% more than would otherwise have been detected), which would lead to an additional 452 surgeries per one million women. Approximately one-third of the screen-detected AAAs are overdiagnosed (actually present but will never cause problems) and 13% are overtreated. The authors estimated that over 30 years of screening, it would cost 30,000 pounds sterling (about US$38,000) for each quality-adjusted life year gained. One would have to invite nearly 4000 women to be screened to prevent one death. Altering their cutoffs to older than 70 years, diagnosis at 2.5 cm, and surgery at 5 cm was more cost-effective and only required 1800 invitations to prevent one death, but it had an overdiagnosis rate of 55%.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Commentaires
I still assume we should be screening in those with strong family histories.
If more physicians would be trained in point of care ultrasound and use it as part of routine in-office physical exams then the question of cost effectiveness would not be an issue.
Another example of how screening can lead to over-diagnosis and over-treatment. The complications and adverse outcomes of surgical treatment for AAA is a further consideration.
Excellent
In this study study, it reveal that screening AAA in women is not very effective . Unnecessary screening lead to over diagnosis and treatment.I think it is just wast of time and money. It is find out that 4000 women needed to be screen to prevent one death. I think is not necessary to screen AAA in women
good poem
Diagnosis of AAA in women is usually missed because the guidelines always recommend screening of men over 65 yrs who ever smoked but it never mentioned women of any age.
I always feel for the AA when I do abdominal exam. I screen obese patients who I can not estimate AA diameter and who are at higher risk for developing AAA - HTN, smokers, FH
Is it worth to screen Women 65 years old with some risk factors ?