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A Sustained Mortality Benefit from Screening for Abdominal Aortic Aneurysm
- Lois G. Kim, MSc;
- R. Alan P. Scott, MCh;
- Hilary A. Ashton, MSc;
- Simon G. Thompson, DSc; and
- for the Multicentre Aneurysm Screening Study Group
- From the Institute of Public Health, Cambridge, United Kingdom, and St. Richard's Hospital, Chichester, United Kingdom.
Abstract
Background: Longer-term mortality benefit and cost-effectiveness for abdominal aortic aneurysm (AAA) screening are uncertain.
Objective: To estimate the benefits, in terms of AAA-related and all-cause mortality, and cost-effectiveness of ultrasonography screening for AAA in a group that was invited to screening compared with a group that was not invited at a mean 7-year follow-up.
Design: Randomized trial.
Setting: 4 centers in the United Kingdom.
Patients: Population-based sample of 67 770 men age 65 to 74 years.
Intervention: Patients with an AAA detected at screening had surveillance and were offered surgery after predefined criteria were met.
Measurements: Mortality data were obtained after flagging on the national database. Unit costs obtained from large samples were applied to individual event data for the cost analysis.
Results: The hazard ratio was 0.53 (95% CI, 0.42 to 0.68) for AAA-related mortality in the group invited for screening. The rupture rate in men with normal results on initial ultrasonography has remained low: 0.54 rupture (CI, 0.25 to 1.02 ruptures) per 10 000 person-years. In terms of all-cause mortality, the observed hazard ratio was 0.96 (CI, 0.93 to 1.00). At the 7-year follow-up, cost-effectiveness was estimated at $19 500 (CI, $12 400 to $39 800) per life-year gained based on AAA-related mortality and $7600 (CI, $3300 to ∞) per life-year gained based on all-cause death. (All values are reported in U.S. dollars [U.K. £1 = U.S. $1.58]).
Limitation: Inclusion of deaths from aortic aneurysm at an unspecified site, which may include some thoracic aortic aneurysms, may have underestimated the treatment effect.
Conclusions: These results from a large, pragmatic randomized trial show that the early mortality benefit of screening ultrasonography for AAA is maintained in the longer term and that the cost-effectiveness of screening improves over time.
International Standard Randomized Controlled Trial registration number: ISRCTN37381646.
Article and Author Information
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Acknowledgment: The authors thank Professor Martin Buxton for comments on a previous version of this paper.
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Grant Support: By the U.K. Medical Research Council. Ms. Kim receives a Raymond and Beverly Sackler Studentship Award.
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Potential Financial Conflicts of Interest: None disclosed.
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Requests for Single Reprints: Lois G. Kim, MSc, MRC Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge CB2 2SR, United Kingdom; e-mail, lois.kim{at}mrc-bsu.cam.ac.uk.
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Current Author Addresses: Ms. Kim and Dr. Thompson: MRC Biostatistics Unit, Institute of Public Health, Robinson Way, Cambridge CB2 2SR, United Kingdom.
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Mr. Scott and Ms. Ashton: Scott Research Unit, Chichester Medical Education Centre, St. Richard's Hospital, Spitalfield Lane, Chichester PO19 6SE, United Kingdom.
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Author Contributions: Conception and design: R.A.P. Scott, H.A. Ashton.
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Analysis and interpretation of the data: L.G. Kim, R.A.P. Scott, H.A. Ashton, S.G. Thompson.
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Drafting of the article: L.G. Kim, R.A.P. Scott, H.A. Ashton.
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Critical revision of the article for important intellectual content: L.G. Kim, R.A.P. Scott, S.G. Thompson.
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Final approval of the article: L.G. Kim, R.A.P. Scott, H.A. Ashton, S.G. Thompson.
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Statistical expertise: L.G. Kim, S.G. Thompson.
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Obtaining of funding: R.A.P. Scott, S.G. Thompson.
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Administrative, technical, or logistic support: R.A.P. Scott, H.A. Ashton.
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Collection and assembly of data: R.A.P. Scott, H.A. Ashton.
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