Advanced

Outcome of the Swedish Nationwide abdominal aortic aneurysm screening program

Wanhainen, Anders; Hultgren, Rebecka; Linné, Anneli; Holst, Jan LU ; Gottsäter, Anders LU ; Langenskiöld, Marcus; Smidfelt, Kristian; Björck, Martin; Svensjö, Sverker and Lyttkens, Linda, et al. (2016) In Circulation 134(16). p.1141-1148
Abstract

Background: A general abdominal aortic aneurysm (AAA) screening program, targeting 65-year-old men, has gradually been introduced in Sweden since 2006 and reached nationwide coverage in 2015. The aim of this study was to determine the outcome of this program. Methods: Data on the number of invited and examined men, screening-detected AAAs, AAAs operated on, and surgical outcome were retrieved from all 21 Swedish counties for the years 2006 through 2014. AAA-specific mortality data were retrieved from the Swedish Cause of Death Registry. A linear regression analysis was used to estimate the effect on AAA-specific mortality among all men ≥65 years of age for the observed time period. The long-term effects were projected by using a... (More)

Background: A general abdominal aortic aneurysm (AAA) screening program, targeting 65-year-old men, has gradually been introduced in Sweden since 2006 and reached nationwide coverage in 2015. The aim of this study was to determine the outcome of this program. Methods: Data on the number of invited and examined men, screening-detected AAAs, AAAs operated on, and surgical outcome were retrieved from all 21 Swedish counties for the years 2006 through 2014. AAA-specific mortality data were retrieved from the Swedish Cause of Death Registry. A linear regression analysis was used to estimate the effect on AAA-specific mortality among all men ≥65 years of age for the observed time period. The long-term effects were projected by using a validated Markov model. Results: Of 302 957 men aged 65 years invited, 84% attended. The prevalence of screening-detected AAA was 1.5%. After a mean of 4.5 years, 29% of patients with AAA had been operated on, with a 30-day mortality rate of 0.9% (1.3% after open repair and 0.3% after endovascular repair, P<0.001). The introduction of screening was associated with a significant reduction in AAA-specific mortality (mean, 4.0% per year of screening, P=0.020). The number needed to screen and the number needed to operate on to prevent 1 premature death were 667 and 1.5, respectively. With a total population of 9.5 million, the Swedish national AAA-screening program was predicted to annually prevent 90 premature deaths from AAA and to gain 577 quality-adjusted life-years. The incremental cost-efficiency ratio was estimated to be €7770 per quality-adjusted life-years. Conclusions: Screening 65-year-old men for AAA is an effective preventive health measure and is highly cost-effective in a contemporary setting. These findings confirm the results from earlier randomized controlled trials and model studies in a large population-based setting of the importance for future healthcare decision making.

(Less)
Please use this url to cite or link to this publication:
@article{007edd8f-2a7f-437b-a19e-9af74fa6a3ce,
  abstract     = {<p>Background: A general abdominal aortic aneurysm (AAA) screening program, targeting 65-year-old men, has gradually been introduced in Sweden since 2006 and reached nationwide coverage in 2015. The aim of this study was to determine the outcome of this program. Methods: Data on the number of invited and examined men, screening-detected AAAs, AAAs operated on, and surgical outcome were retrieved from all 21 Swedish counties for the years 2006 through 2014. AAA-specific mortality data were retrieved from the Swedish Cause of Death Registry. A linear regression analysis was used to estimate the effect on AAA-specific mortality among all men ≥65 years of age for the observed time period. The long-term effects were projected by using a validated Markov model. Results: Of 302 957 men aged 65 years invited, 84% attended. The prevalence of screening-detected AAA was 1.5%. After a mean of 4.5 years, 29% of patients with AAA had been operated on, with a 30-day mortality rate of 0.9% (1.3% after open repair and 0.3% after endovascular repair, P&lt;0.001). The introduction of screening was associated with a significant reduction in AAA-specific mortality (mean, 4.0% per year of screening, P=0.020). The number needed to screen and the number needed to operate on to prevent 1 premature death were 667 and 1.5, respectively. With a total population of 9.5 million, the Swedish national AAA-screening program was predicted to annually prevent 90 premature deaths from AAA and to gain 577 quality-adjusted life-years. The incremental cost-efficiency ratio was estimated to be €7770 per quality-adjusted life-years. Conclusions: Screening 65-year-old men for AAA is an effective preventive health measure and is highly cost-effective in a contemporary setting. These findings confirm the results from earlier randomized controlled trials and model studies in a large population-based setting of the importance for future healthcare decision making.</p>},
  author       = {Wanhainen, Anders and Hultgren, Rebecka and Linné, Anneli and Holst, Jan and Gottsäter, Anders and Langenskiöld, Marcus and Smidfelt, Kristian and Björck, Martin and Svensjö, Sverker and Lyttkens, Linda and Pihl, Ewa and Wetterling, Tomas and Kjellin, Per and Eliasson, Ken and Wellander, Erik and Narbani, Azin and Skagius, Elisabet and Hollsten, Alexandra and Welander, Martin and Länne, Toste and Fröst, Bibbi and Korman, David and Persson, Sven Erik and Sigvant, Birgitta and Troëng, Thomas and Palm, Markus and Ansgarius, Eva and Gilgen, Nils Peter and Sjöström, Christina and Gidlund, Khatereh Djavani and Danielsson, Peter and Bersztel, Adam and Jonasson, Tomas},
  issn         = {0009-7322},
  keyword      = {aneurysm,aorta,cost-benefit analysis,prevention and control,screening,ultrasonography},
  language     = {eng},
  month        = {10},
  number       = {16},
  pages        = {1141--1148},
  publisher    = {Lippincott Williams and Wilkins},
  series       = {Circulation},
  title        = {Outcome of the Swedish Nationwide abdominal aortic aneurysm screening program},
  url          = {http://dx.doi.org/10.1161/CIRCULATIONAHA.116.022305},
  volume       = {134},
  year         = {2016},
}