SCREENING OF THE ABDOMINAL AORTIC ANEURYSM: COST-EFFECTIVENESS AND HEALTH BENEFITS

Authors

  • João Teles General and Family Medicine, Unidade de Saúde Familiar de Fânzeres, Agrupamento de Centros de Saúde de Gondomar, Portugal
  • Nuno Teles General and Family Medicine, Unidade de Saúde Familiar de Fânzeres, Agrupamento de Centros de Saúde de Gondomar, Portugal
  • Hélder Sousa General and Family Medicine, Unidade de Saúde Familiar de Fânzeres, Agrupamento de Centros de Saúde de Gondomar, Portugal

DOI:

https://doi.org/10.48729/pjctvs.168

Keywords:

Aortic Aneurysm, Abdominal, Prevalence, Mass Screening

Abstract

Introduction: The abdominal aortic aneurysm (AAA) is a nosological entity whose main complication is rupture, being associated with a high mortality rate. The early identification of this pathology in groups at risk through an ultrasound screening program can have benefits based on elective surgical repair before the rupture occurs, preventing death. In Portugal, no screening program for this aneurysm is implemented. Our goal is to review the impact of screening among risk groups on the global and aneurysm-related mortality rates, quality of life, cost-effectiveness and its applicability in Portugal.

Materials and methods: We performed a narrative review of the literature on screening for AAA.

Results: There is evidence that screening is effective in reducing aneurysm-related mortality in men aged 65 and over, but not in reducing overall mortality. In addition, the implementation of a screening program in several countries appears to be cost-effective in at-risk populations.

Discusssion and conclusion: Data from epidemiological studies on AAA suggests that the implementation of an AAA screening program, based on ultrasound, in men aged 65 and over, can bring health benefits and be cost-effective. Even so, taking into account that all the studies took place outside Portugal, the possibility of generalizing the results to the portuguese population is not clear.

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References

B. Desjardins, K.E. Dill, S.D. Flamm, C.J. Francois, M.D. Gerhard-Herman, S.P. Kalva, M.A. Mansour, E.R. Mohler, I.B. Oliva, M.P. Schenker, ACR Appropriateness Criteria® pulsatile abdominal mass, suspected abdominal aortic aneurysm, The international journal of cardiovascular imaging 29(1) (2013) 177-183.

A. Wanhainen, How to define an abdominal aortic aneurysm — influence on epidemiology and clinical practice, Scandinavian Journal of Surgery 97(2) (2008) 105-109.

K. Singh, K. Bønaa, B. Jacobsen, L. Bjørk, S. Solberg, Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study: The Tromsø Study, American journal of epidemiology 154(3) (2001) 236-244.

S.H. Forsdahl, K. Singh, S. Solberg, B.K. Jacobsen, Risk factors for abdominal aortic aneurysms, Circulation 119(16) (2009) 2202-2208.

S.C. Harrison, S.E. Humphries, Regarding “Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals”, Journal of vascular surgery 53(1) (2011) 263-264.

D.H. Kim, G. Van Ginhoven, D.M. Milewicz, Familial aggregation of both aortic and cerebral aneurysms: evidence for a common genetic basis in a subset of families, Neurosurgery 56(4) (2005) 655-661.

E.L. Chaikof, R.L. Dalman, M.K. Eskandari, B.M. Jackson, W.A. Lee, M.A. Mansour, T.M. Mastracci, M. Mell, M.H. Murad, L.L. Nguyen, The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm, Journal of vascular surgery 67(1) (2018) 2-77. e2.

R. Scott, M.A.S.S. Group, The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial, The Lancet 360(9345) (2002) 1531-1539.

P.E. Norman, K. Jamrozik, M.M. Lawrence-Brown, M.T. Le, C.A. Spencer, R.J. Tuohy, R.W. Parsons, J.A. Dickinson, Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm, Bmj 329(7477) (2004) 1259.

J.S. Lindholt, S. Juul, H. Fasting, E.W. Henneberg, Screening for abdominal aortic aneurysms: single centre randomised controlled trial, Bmj 330(7494) (2005) 750.

H. Ashton, L. Gao, L. Kim, P. Druce, S. Thompson, R. Scott, Fifteen‐year follow‐up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms, British Journal of Surgery: Incorporating European Journal of Surgery and Swiss Surgery 94(6) (2007) 696-701.

J. Fernandes, A. Natário, A. Matos, Rede de Referenciação Hospitalar Angiologia e Cirurgia Vascular, SNS, ed: Republica Portuguesa (2017) 34-39.

R. Castro-Ferreira, P. Mendes, P. Couto, R. Barreira, F. Peixoto, M. Aguiar, M. Neto, D. Rolim, J. Pinto, A. Freitas, Rastreio populacional de aneurisma da aorta abdominal em Portugal–o imperativo da sua realização, Angiologia e Cirurgia Vascular 12(4) (2016) 267-270.

H.-H. Eckstein, D. Böckler, I. Flessenkämper, T. Schmitz-Rixen, S. Debus, W. Lang, Ultrasonographic screening for the detection of abdominal aortic aneurysms, Deutsches Ärzteblatt International 106(41) (2009) 657.

E.L. Chaikof, D.C. Brewster, R.L. Dalman, M.S. Ma karoun, K.A. Illig, G.A. Sicard, C.H. Timaran, G.R. Upchurch, F.J. Veith, The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines, Journal of vascular surgery 50(4) (2009) S2-S49.

P. Basnyat, A. Biffin, L. Moseley, A. Hedges, M. Lewis, Mortality from ruptured abdominal aortic aneurysm in Wales, British Journal of Surgery 86(6) (1999) 765-770.

K.W. Johnston, Ruptured abdominal aortic aneurysm: six-year follow-up results of a multicenter prospective study, Journal of vascular surgery 19(5) (1994) 888-900.

J.S. Lindholt, S. Vammen, S. Juul, E. Henneberg, H. Fasting, The validity of ultrasonographic scanning as screening method for abdominal aortic aneurysm, European journal of vascular and endovascular surgery 17(6) (1999) 472-475.

F.A. Lederle, J.M. Walker, D.B. Reinke, Selective screening for abdominal aortic aneurysms with physical examination and ultrasound, Archives of internal medicine 148(8) (1988) 1753-1756.

V.S. Tayal, C.D. Graf, M.A. Gibbs, Prospective study of accuracy and outcome of emergency ultrasound for abdominal aortic aneurysm over two years, Academic Emergency Medicine 10(8) (2003) 867-871.

T.G. Costantino, E.C. Bruno, N. Handly, A.J. Dean, Accuracy of emergency medicine ultrasound in the evaluation of abdominal aortic aneurysm, The Journal of emergency medicine 29(4) (2005) 455-460.

R.A. Benson, R. Poole, S. Murray, P. Moxey, I.M. Loftus, Screening results from a large United Kingdom abdominal aortic aneurysm screening center in the context of optimizing United Kingdom National Abdominal Aortic Aneurysm Screening Programme protocols, Journal of vascular surgery 63(2) (2016) 301-304.

S. Svensjö, K. Mani, M. Björck, J. Lundkvist, A. Wanhainen, Screening for abdominal aortic aneurysm in 65-year-old men remains cost-effective with contemporary epidemiology and management, European Journal of Vascular and Endovascular Surgery 47(4) (2014) 357-365.

S. Thompson, H. Ashton, L. Gao, M. Buxton, R. Scott, Multicentre Aneurysm Screening Study G. Final follow-up of the Multicentre Aneurysm Screening Study (MASS) randomized trial of abdominal aortic aneurysm screening, Br J Surg 99(12) (2012) 1649-56.

J.S. Lindholt, J. Sørensen, R. Søgaard, E. Henneberg, Long-term benefit and cost-effectiveness analysis of screening for abdominal aortic aneurysms from a randomized controlled trial, British journal of surgery 97(6) (2010) 826-834.

K.A. McCaul, M. Lawrence-Brown, J.A. Dickinson, P.E. Norman, Long-term outcomes of the Western Australian trial of screening for abdominal aortic aneurysms: secondary analysis of a randomized clinical trial, JAMA internal medicine 176(12) (2016) 1761-1767.

R. Scott, N. Wilson, H. Ashton, D. Kay, Influence of screening on the incidence of ruptured abdominal aor-tic aneurysm: 5-year results of a randomized controlled study, British Journal of Surgery 82(8) (1995) 1066-1070.

K. Vardulaki, N. Walker, E. Couto, N. Day, S. Thompson, H. Ashton, R. Scott, Late results concerning feasibility and compliance from a randomized trial of ultrasonographic screening for abdominal aortic aneurysm, British journal of surgery 89(7) (2002) 861-864.

S. Thompson, H. Ashton, L. Gao, R. Scott, Screening men for abdominal aortic aneurysm: 10 year mortality and cost effectiveness results from the randomised Multicentre Aneurysm Screening Study, Bmj 338 (2009) b2307.

P.A. Cosford, G.C. Leng, J. Thomas, Screening for abdominal aortic aneurysm, Cochrane database of systematic reviews (2) (2007).

J.S. Lindholt, P. Norman, Screening for abdominal aortic aneurysm reduces overall mortality in men. A meta-analysis of the mid-and long-term effects of screening for abdominal aortic aneurysms, European Journal of Vascular and Endovascular Surgery 36(2) (2008) 167-171.

H. Takagi, S.-n. Goto, M. Matsui, H. Manabe, T. Umemoto, A further meta-analysis of population-based screening for abdominal aortic aneurysm, Journal of vascular surgery 52(4) (2010) 1103-1108.

H. Takagi, T. Ando, T. Umemoto, Abdominal aortic aneurysm screening reduces all-cause mortality: make screening great again, Angiology 69(3) (2018) 205-211.

P.C. Gøtzsche, Relation between breast cancer mortality and screening effectiveness: systematic review of the mammography trials, Dan Med Bull 58(3) (2011) A4246.

P. Hewitson, P. Glasziou, E. Watson, B. Towler, L. Irwig, Cochrane systematic review of colorectal cancer screening using the fecal occult blood test (hemoccult): an update, American Journal of Gastroenterology 103(6) (2008) 1541-1549.

A. Wanhainen, R. Hultgren, A. Linné, J. Holst, A. Gottsäter, M. Langenskiöld, K. Smidfelt, M. Björck, S. Svensjö, S.A.S.S. Group, Outcome of the Swedish nationwide abdominal aortic aneurysm screening program, Circulation 134(16) (2016) 1141-1148.

J. Jacomelli, L. Summers, A. Stevenson, T. Lees, J. Earnshaw, Impact of the first 5 years of a national abdominal aortic aneurysm screening programme, British Journal of Surgery 103(9) (2016) 1125-1131.

M. Davis, M. Harris, J.J. Earnshaw, Implementation of the national health service abdominal aortic aneurysm screening program in England, Journal of vascular surgery 57(5) (2013) 1440-1445.

N. Olchanski, A. Winn, J. Cohen, P. Neumann, Abdominal aortic aneurysm screening: how many life years lost from underuse of the medicare screening benefit?, Journal of general internal medicine 29(8) (2014) 1155-1161.

J.B. Shreibati, L.C. Baker, M.A. Hlatky, M.W. Mell, Impact of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act on abdominal ultrasonography use among medicare beneficiaries, Archives of internal medicine 172(19) (2012) 1456-1462.

M.D. Rawlins, A.J. Culyer, National Institute for Clinical Excellence and its value judgments, Bmj 329(7459) (2004) 224-227.

M. Glover, L. Kim, M. Sweeting, S. Thompson, M. Buxton, Cost-effectiveness of the National Health Service abdominal aortic aneurysm screening programme in England, British Journal of Surgery 101(8) (2014) 976-982.

J.S. Lindholt, S. Vammen, H. Fasting, E. Henneberg, Psychological consequences of screening for abdominal aortic aneurysm and conservative treatment of small abdominal aortic aneurysms, European Journal of Vascular and Endovascular Surgery 20(1) (2000) 79-83.

F.A. Lederle, R.L. Kane, R. MacDonald, T.J. Wilt, Systematic review: repair of unruptured abdominal aortic aneurysm, Annals of internal medicine 146(10) (2007) 735-741.

M.L. Schermerhorn, D.B. Buck, A.J. O’Malley, T. Curran, J.C. McCallum, J. Darling, B.E. Landon, Long-term outcomes of abdominal aortic aneurysm in the Medicare population, New england journal of medicine 373(4) (2015) 328-338.

P. Cao, P. De Rango, F. Verzini, G. Parlani, L. Romano, E. Cieri, C.T. Group, Comparison of surveillance versus aortic endografting for small aneurysm repair (CAESAR): results from a randomised trial, European Journal of Vascular and Endovascular Surgery 41(1) (2011) 13-25.

K. Ouriel, D.G. Clair, K.C. Kent, C.K. Zarins, P.I.o.E.O.f.t.A.E. Investigators, Endovascular repair compared with surveillance for patients with small abdominal aortic aneurysms, Journal of vascular surgery 51(5) (2010) 1081-1087.

F.A. Lederle, S.E. Wilson, G.R. Johnson, D.B. Reinke, F.N. Littooy, C.W. Acher, D.J. Ballard, L.M. Messina, I.L. Gordon, E.P. Chute, Immediate repair compared with surveillance of small abdominal aortic aneurysms, New England Journal of Medicine 346(19) (2002) 1437-1444.

C.T.F.o.P.H. Care, Recommendations on screening for abdominal aortic aneurysm in primary care, CMAJ 189(36) (2017) E1137-E1145.

A. Wanhainen, F. Verzini, I. Van Herzeele, E. Allaire, M. Bown, T. Cohnert, F. Dick, J. van Herwaarden, C. Karkos, M. Koelemay, European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms (vol 57, pg 8, 2019), European Journal of Vascular and Endovascular Surgery 59(3) (2020) 494-494.

M.L. LeFevre, Screening for abdominal aortic aneurysm: US Preventive Services Task Force recommendation statement, Annals of internal medicine 161(4) (2014) 281-290.

A.T. Hirsch, Z.J. Haskal, N.R. Hertzer, C.W. Bakal, M.A. Creager, J.L. Halperin, L.F. Hiratzka, W.R. Murphy, J.W. Olin, J.B. Puschett, ACC/AHA 2005 practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic) a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery,* Society for Cardiovascular Angiography

and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (writing committee to develop guidelines for the management of patients with peripheral arterial disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation, circulation 113(11) (2006) e463-e654.

A.W. Beck, A. Sedrakyan, J. Mao, M. Venermo, R. Faizer, S. Debus, C.-A. Behrendt, S. Scali, M. Altreuther, M. Schermerhorn, Variations in abdominal aortic aneurysm care: a report from the International Consortium of Vascular Registries, Circulation 134(24) (2016) 1948-1958.

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Published

02-07-2021

How to Cite

1.
Teles J, Teles N, Sousa H. SCREENING OF THE ABDOMINAL AORTIC ANEURYSM: COST-EFFECTIVENESS AND HEALTH BENEFITS. Rev Port Cir Cardiotorac Vasc [Internet]. 2021 Jul. 2 [cited 2024 Apr. 26];28(2):39-48. Available from: https://pjctvs.com/index.php/journal/article/view/168

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Review Article