RT Journal Article
SR Electronic
T1 One-time screening for abdominal aortic aneurysm in Ontario, Canada: a model-based cost-utility analysis
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E112
OP E120
DO 10.1503/cmaj.230913
VO 196
IS 4
A1 Dominique Vervoort
A1 Grishma Hirode
A1 Thomas F. Lindsay
A1 Derrick Y. Tam
A1 Varun Kapila
A1 Charles de Mestral
YR 2024
UL http://www.cmaj.ca/content/196/4/E112.abstract
AB Background: Screening programs for abdominal aortic aneurysm (AAA) are not available in Canada. We sought to determine the effectiveness and costutility of AAA screening in Ontario.Methods: We compared one-time ultrasonography-based AAA screening for people aged 65 years to no screening using a fully probabilistic Markov model with a lifetime horizon. We estimated life-years, quality-adjusted life-years (QALYs), AAA-related deaths, number needed to screen to prevent 1 AAA-related death and costs (in Canadian dollars) from the perspective of the Ontario Ministry of Health. We retrieved model inputs from literature, Statistics Canada, and the Ontario Case Costing Initiative.Results: Screening reduced AAA-related deaths by 84.9% among males and 81.0% among females. Compared with no screening, screening resulted in 0.04 (18.96 v. 18.92) additional life-years and 0.04 (14.95 v. 14.91) additional QALYs at an incremental cost of $80 per person among males. Among females, screening resulted in 0.02 (21.25 v. 21.23) additional life-years and 0.01 (16.20 v. 16.19) additional QALYs at an incremental cost of $11 per person. At a willingness-to-pay of $50 000 per year, screening was cost-effective in 84% (males) and 90% (females) of model iterations. Screening was increasingly cost-effective with higher AAA prevalence.Interpretation: Screening for AAA among people aged 65 years in Ontario was associated with fewer AAA-related deaths and favourable cost-effectiveness. To maximize QALY gains per dollar spent and AAA-related deaths prevented, AAA screening programs should be designed to ensure that populations with high prevalence of AAA participate.