Effective, But Will It Be Cost Effective?

This paper gives a clear and comprehensive account of outcomes up to 10 years in 65 year old men with sub-aneurysmal aorta (SAA) managed as part national screening programme.1Thorbjørnsen K. Svensjö S. Gilgen N.P. Wanhainen A. Long term outcome detected aortas men: single scan after five identifies those at risk needing abdominal aortic aneurysm repair.Eur J Vasc Endovasc Surg. 2021; 62: 380-386Abstract Full Text PDF Scopus (2) Google Scholar The data are unique most programmes do not offer surveillance this group. population includes some whose aneurysms (AAAs) were discovered incidentally, which reduces the purity scientific value cohort, stratified for proper modelling benefits cost effectiveness rescreening is reported. Nevertheless, it likely reflect real world practice clinical progression SAA. results very similar prospective evaluation from Gloucestershire AAA programme,2Oliver-Williams C. Sweeting M.J. Turton G. Parkin D. Cooper Rodd et al.for Swindon Abdominal Aortic Aneurysm Screening Programme. Lessons learned about prevalence growth rates 25-year ultrasound programme.Br 2018; 105: 68-74Crossref PubMed (57) where was also found that an diameter > 3 cm 70 age good predictor 5.5 will develop, well seen numerous cohorts worldwide, instance reported meta-analysis by Wild al.3Wild J.B. Stather P.W. Biancari F. Choke E.C. Earnshaw J.J. Grant S.W. al.A multicentre observational study dilatation.Eur 2013; 45: 128-134Abstract (53) authors state their suggest SAA should be effective. However, argument somewhat one sided. Here, years, only 41 original 1 020 developed cm. headline figure 30% reach current threshold intervention within based on 142 who had follow up. Only few these unfit intervention; endovascular repair (EVAR) or fenestrated EVAR. Whether you agree National Institute Health Care Excellence (NICE) guidelines, technical analysis disputed, interventions In addition, harms long mentioned (anxiety, reduced quality life, etc). Finally, many cohort develop AAAs eighties, when they may (or unwilling) elective treatment. group, risks treatment yet outweigh benefits.4Earnshaw indication reviewed.Eur 61: 7-8Abstract applauded efforts, encouraged continue collect 15 formal analysis, conducted rigour NICE analysis. A previous Danish VIVA trial suggested proportion lost for, unwilling undergo, increase age.5Sogaard R. Laustsen J. Lindholt J.S. Cost modern context: hypothetical using decision analytical model.BMJ. 2012; 345e4276Crossref (56) Consideration given stratifying screen incidental avoid any bias inclusion incidentally Until then, recommended outside research studies. Term Outcome Screen Detected Sub-Aneurysmal Aortas Year Old Men: Single Scan After Five Years Identifies Those Risk Needing RepairEuropean Journal Vascular Endovascular SurgeryVol. 62Issue 3PreviewThe epidemiology dilatation 25 – 29 mm fully understood, management debated. Lack evidence particularly problematic setting. aimed evaluate SAAs, focusing (AAA), reaching surgical repair. Full-Text Open Access