Outcome of the Swedish Nationwide Abdominal Aortic Aneurysm Screening Program
2016 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 134, no 16, 1141-1148 p.Article in journal (Refereed) Published
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.
Place, publisher, year, edition, pages
2016. Vol. 134, no 16, 1141-1148 p.
Cardiac and Cardiovascular Systems
IdentifiersURN: urn:nbn:se:uu:diva-308344DOI: 10.1161/CIRCULATIONAHA.116.022305ISI: 000386483600009PubMedID: 27630132OAI: oai:DiVA.org:uu-308344DiVA: diva2:1049441