Cost-effectiveness of targeted screening for abdominal aortic aneurysm - Monte Carlo-based estimates

Objectives: This article reports a cost-effectiveness analysis of targeted screening for abdominal aortic aneurysm (AAA). A major emphasis was on the estimation of distributions of costs and effectiveness. Methods: We performed a Monte Carlo simulation using C programming language in a PC environment. Data on survival and costs, and a majority of screeni ng probabilities, were from our own empirical studies. Natural history data were based on the literature. Results: Each screened male gained 0.07 life-years at an incremental cost o f FIM 3,300. The expected values differed from zero very significantly. For females, expected gains were 0.02 life-years at an incremental cost of FIM 1,100, which was not statistically significant. Cost-effectiveness ratios and their 95% confidence intervals were FIM 48,000 (27,000-121,000) and 54, 000 (22,000-infinity) for males and females, respectively. Sensitivity anal ysis revealed that the results for mates were stable. Individual variation in life-year gains was high. Conclusions: Males seemed to benefit from targeted AAA screening, and the r esults were stable. As far as the cost-effectiveness ratio is considered ac ceptable, screening for males seemed to be justified. However, our assumpti ons about growth and rupture behavior of AAAs might be improved with furthe r clinical and epidemiological studies. As a point estimate, females benefi ted in a similar manner, but the results were not statistically significant . The evidence of this study did not justify screening of females.