Open AccessCost‐effectiveness of the National Health Service abdominal aortic aneurysm screening programme in England
Author(s) -
Glover M. J.,
Kim L. G.,
Sweeting M. J.,
Thompson S. G.,
Buxton M. J.
Publication year - 2014
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1002/bjs.9528
Subject(s) - medicine , abdominal aortic aneurysm , confidence interval , cost effectiveness , attendance , quality adjusted life year , aneurysm , emergency medicine , demography , surgery , risk analysis (engineering) , economics , economic growth , sociology
Background Implementation of the National Health Service abdominal aortic aneurysm ( AAA ) screening programme ( NAAASP ) for men aged 65 years began in England in 2009. An important element of the evidence base supporting its introduction was the economic modelling of the long‐term cost‐effectiveness of screening, which was based mainly on 4‐year follow‐up data from the Multicentre Aneurysm Screening Study ( MASS ) randomized trial. Concern has been expressed about whether this conclusion of cost‐effectiveness still holds, given the early performance parameters, particularly the lower prevalence of AAA observed in NAAASP . Methods The existing published model was adjusted and updated to reflect the current best evidence. It was recalibrated to mirror the 10‐year follow‐up data from MASS ; the main cost parameters were re‐estimated to reflect current practice; and more robust estimates of AAA growth and rupture rates from recent meta‐analyses were incorporated, as were key parameters as observed in NAAASP (attendance rates, AAA prevalence and size distributions). Results The revised and updated model produced estimates of the long‐term incremental cost‐effectiveness of £5758 (95 per cent confidence interval £4285 to £7410) per life‐year gained, or £7370 (£5467 to £9443) per quality‐adjusted life‐year ( QALY ) gained. Conclusion Although the updated parameters, particularly the increased costs and lower AAA prevalence, have increased the cost per QALY , the latest modelling provides evidence that AAA screening as now being implemented in England is still highly cost‐effective.