POPULATION SCREENING FOR ABDOMINAL AORTIC-ANEURYSM - DO THE BENEFITS OUTWEIGH THE COSTS

To prevent the high mortality rate associated with ruptured abdominal aortic aneursym (AAA), population screening at or soon after retiremen t age has been advocated, with elective operations being performed on patients with the appropriate indications. There is considerable press ure on some health authorities to fund such programmes even though the re is substantial uncertainty about the consequent benefits. The ultra sound screening test is acceptable and accurate. Also, other health pr oblems may be detected in the same screen. However, screening would le ad to a questionable increase in surgery, as most patients with AAA di e from other causes and not from a ruptured aneurysm. In addition, the re is an elective operative mortality of around 5 per cent. Furthermor e, as many of those who have a positive result on screening would neve r have known that they harbour an aneurysm, there is the possibility o f unnecessary anxiety arising from the test. An economic analysis has been conducted for two identical, hypothetical cohorts of men using th e best available data. One cohort was assumed to undergo screening and a number of men were indicated for immediate elective aneurysm repair or for follow-up, and surgery if their aneurysms become large. The ot her cohort was assumed not to be screened and would thereby face the p ossibility of rupture with its adverse outcome. The survival prospects of the two cohorts were calculated as life expectancies and in terms of life-years: the incremental life-years gained were compared with th e incremental costs of the programme. Although there are considerable uncertainties in the analysis parameters, the base-line result and sen sitivity analysis indicate that, on the basis of current knowledge, po pulation screening should not be introduced.