Hospital costs and benefits of screening for abdominal aortic aneurysms. Results from a randomised population screening trial

Abstract

Objectives: to analyse the hospital costs and benefits of screening older males for abdominal aortic aneurysm (AAA).

Materials and methods: in 1994 a hospital-based screening trial of 12 658 65-73-year-old males was started. AAA >5 cm were referred for surgery. The remaining AAA were offered annual scans. Those with aortic ectasia were rescreened at 5 yearly intervals. AAA-operations and hospital AAA-related deaths were researched. The costs of screening, surveillance, and treatment were also registered.

Results: the attendance rate was 76%; of whom 191 (4.0%) had AAA. Mean observation time was 5.13 years. Sixty in the screened and 41 in the control group were operated (p=0.06), of which 7 and 27 respectively were operated as an emergency (p<0.001), and 6 and 19 respectively died due to AAA (p=0.009). The costs per scan were 83.50 DKK, 81 400 DKK per emergency operation (71 485 DKK after screening), and 117 000 DKK per emergency operation. The cost per prevented hospital death was 67 855 DKK, equivalent to approximately life year saved approx. 7540 DKK (GBP1=12 DKK).

Conclusion: screening appears to reduce hospital AAA mortality and to be cost-effective.