Transcript poster Haag april 2010

Screening – HTA – Policymaking
Consequences of population screening for abdominal
aortic aneurysm (AAA) – a health technology assessment
Kjølby M1, Løvschall C1, Jensen LG1, Væggemose U1, Bech M2, Ehlers L3
1 Department of HTA, Institute of Public Health, Aarhus University, Denmark
2 The Projectdepartment for The New University Hospital in Aarhus, Denmark
3 Health Economics and Management, Aalborg University, Denmark
Background: Abdominal
aortic aneurysm (AAA) is a
severe pathology with a
prevalence of 4-8% in men over
65 years of age. AAA rarely gives
rise to symptoms until its
rupture, which shows very high
mortality rates (70-95%).
The evidence base for treatment is
relatively clear. Its diagnosis is
established by means of
ultrasonography, which is of low
cost, well accepted and has a high
sensibility and specificity.
Depending on the size of the
aneurism elective repair is
offered in order to avoid
rupture.
Findings: AAA screening for
men aged 65-74 reduces the
mortality related to this pathology.
The assessment also found that the
introduction of AAA screening is not
cost-efficient provided that a willingness to pay threshold of approx. £ 30,000
per QALY is adopted. Other aspects
related to the patient, organization and
ethics does not provide any clear indication as to whether AAA screening should
be recommended or not.
Objective:
The objectives of this health
technology assessment was to
assess the evidence base for the
effect of AAA population screening
and to evaluate the consequences of
implementing a screening programme
for men aged 65-74 in Denmark, also
including patient-related, organizational,
economic and ethical consequences.
Methods: The analysis of the evidence
for the effect of AAA population screening and of the patient-related aspects
including an ethical analysis were
based on a systematic review of
published HTA reports, reviews
and primary studies. The analysis
of organizational and economic
aspects was based partly on
a literature survey and
partly on collected data
and register data.
Conclusions: The assessment of the different aspects of implementing a screening programme compared to alternative
strategies shows a complex of pros and cons towards implementation. The literature review shows that AAA screening of males
aged 65-75 years can reduce AAA mortality, however screening does not seem to be cost-effective.
Recommendations:
• Implementing screening programmes is of such importance and affects national health services in a way that it
must allways be considered a national matter.
• Screening programmes must allways assume a public health perspective in order to assess all relevant
consequences of the programme.
• Establishing a national organization on how to conduct decision making processes and evaluating existing
programmes is recommended.
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