Cost effectiveness of abdominal aortic aneurysm screening and rescreening in men in a modern context: evaluation of a hypothetical cohort using a decision analytical model

OBJECTIVE To assess the cost effectiveness of different screening strategies for abdominal aortic aneurysm in men, from the perspective of a national health service. SETTING Screening units at regional hospitals. PARTICIPANTS Hypothetical cohort of 65 year old men from the general population. MAIN OUTCOME MEASURES Costs (£ in 2010) and effect on health outcomes (quality adjusted life years (QALYs)). RESULTS Screening seems to be highly cost effective compared with not screening. The model estimated a 92% probability that some form of screening would be cost effective at a threshold of £20,000 (€24,790; $31,460). If men with an aortic diameter of 25-29 mm at the initial screening were rescreened once after five years, 452 men per 100,000 initially screened would benefit from early detection, whereas lifetime rescreening every five years would detect 794 men per 100,000. We estimated the associated incremental cost effectiveness ratios for rescreening once and lifetime rescreening to be £10,013 and £29,680 per QALY, respectively. The individual probability of being the most cost effective strategy was higher for each rescreening strategy than for the screening once strategy (in view of the £20,000 threshold). CONCLUSIONS This study confirms the cost effectiveness of screening versus no screening and lends further support to considerations of rescreening men at least once for abdominal aortic aneurysm.