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A sustained mortality benefit from screening for abdominal aortic aneurysm.

Abstract：

BACKGROUND:Longer-term mortality benefit and cost-effectiveness for abdominal aortic aneurysm (AAA) screening are uncertain. OBJECTIVE:To estimate the benefits, in terms of AAA-related and all-cause mortality, and cost-effectiveness of ultrasonography screening for AAA in a group that was invited to screening compared with a group that was not invited at a mean 7-year follow-up. DESIGN:Randomized trial. SETTING:4 centers in the United Kingdom. PATIENTS:Population-based sample of 67,770 men age 65 to 74 years. INTERVENTION:Patients with an AAA detected at screening had surveillance and were offered surgery after predefined criteria were met. MEASUREMENTS:Mortality data were obtained after flagging on the national database. Unit costs obtained from large samples were applied to individual event data for the cost analysis. RESULTS:The hazard ratio was 0.53 (95% CI, 0.42 to 0.68) for AAA-related mortality in the group invited for screening. The rupture rate in men with normal results on initial ultrasonography has remained low: 0.54 rupture (CI, 0.25 to 1.02 ruptures) per 10 000 person-years. In terms of all-cause mortality, the observed hazard ratio was 0.96 (CI, 0.93 to 1.00). At the 7-year follow-up, cost-effectiveness was estimated at $19 500 (CI, $12,400 to $39,800) per life-year gained based on AAA-related mortality and $7600 (CI, $3300 to infinity) per life-year gained based on all-cause death. (All values are reported in U.S. dollars [U.K. 1 pound sterling = U.S. $1.58]). LIMITATION:Inclusion of deaths from aortic aneurysm at an unspecified site, which may include some thoracic aortic aneurysms, may have underestimated the treatment effect. CONCLUSIONS:These results from a large, pragmatic randomized trial show that the early mortality benefit of screening ultrasonography for AAA is maintained in the longer term and that the cost-effectiveness of screening improves over time. International Standard Randomized Controlled Trial registration number: ISRCTN37381646.

journal_name

Ann Intern Med

journal_title

Annals of internal medicine

authors

Kim LG,P Scott RA,Ashton HA,Thompson SG,Multicentre Aneurysm Screening Study Group.

doi

10.7326/0003-4819-146-10-200705150-00003

subject

Has Abstract

pub_date

2007-05-15 00:00:00

pages

699-706

issue

eissn

0003-4819

issn

1539-3704

pii

146/10/699

journal_volume

146

pub_type

杂志文章,多中心研究,随机对照试验

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A sustained mortality benefit from screening for abdominal aortic aneurysm.