Anders Wanhainen1, Rebecka Hultgren2, Anneli Linné2, Jan Holst2, Anders Gottsäter2, Marcus Langenskiöld2, Kristian Smidfelt2, Martin Björck2, Sverker Svensjö2. 1. From Department of Surgical Sciences, Uppsala University, Sweden (A.W., M.B., S.S.); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (R.H.); Department of Surgery and Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden (A.L.); Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden (J.H., A.G.); Department of Vascular Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden (K.S., M.L.); and Department of Surgery, Falun County Hospital, Falun, Sweden (S.S.). anders.wanhainen@surgsci.uu.se. 2. From Department of Surgical Sciences, Uppsala University, Sweden (A.W., M.B., S.S.); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (R.H.); Department of Surgery and Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden (A.L.); Department of Vascular Diseases, Skåne University Hospital, Malmö, Sweden (J.H., A.G.); Department of Vascular Surgery, Sahlgrenska University Hospital, University of Gothenburg, Sweden (K.S., M.L.); and Department of Surgery, Falun County Hospital, Falun, Sweden (S.S.).
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 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.
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.
Authors: Kevin C Chun; Richard C Anderson; Hunter C Smothers; Kanika Sood; Zachary T Irwin; Machelle D Wilson; Eugene S Lee Journal: J Vasc Surg Date: 2019-11-07 Impact factor: 4.268
Authors: Kevin C Chun; Kelly J Dolan; Hunter C Smothers; Zachary T Irwin; Richard C Anderson; Arlene L Gonzalves; Eugene S Lee Journal: J Vasc Surg Date: 2019-03-25 Impact factor: 4.268
Authors: Alexandra C Sundermann; Keith Saum; Kelsey A Conrad; Hannah M Russell; Todd L Edwards; Kevin Mani; Martin Björck; Anders Wanhainen; A Phillip Owens Journal: Blood Adv Date: 2018-11-27