دورية أكاديمية
Analysis of clinical benefit, harms, and cost-effectiveness of screening women for abdominal aortic aneurysm
| العنوان: | Analysis of clinical benefit, harms, and cost-effectiveness of screening women for abdominal aortic aneurysm |
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| المؤلفون: | Sweeting, MJ, Masconi, KL, Jones, E, Ulug, P, Glover, MJ, Michaels, JA, Bown, MJ, Powell, JT, Thompson, SG |
| المساهمون: | National Institute for Health Research |
| المصدر: | 495 ; 487 |
| بيانات النشر: | Elsevier |
| سنة النشر: | 2018 |
| المجموعة: | Imperial College London: Spiral |
| مصطلحات موضوعية: | 11 Medical And Health Sciences, General & Internal Medicine |
| جغرافية الموضوع: | England |
| الوصف: | BACKGROUND: A third of deaths in the UK from ruptured abdominal aortic aneurysm (AAA) are in women. In men, national screening programmes reduce deaths from AAA and are cost-effective. The benefits, harms, and cost-effectiveness in offering a similar programme to women have not been formally assessed, and this was the aim of this study. METHODS: We developed a decision model to assess predefined outcomes of death caused by AAA, life years, quality-adjusted life years, costs, and the incremental cost-effectiveness ratio for a population of women invited to AAA screening versus a population who were not invited to screening. A discrete event simulation model was set up for AAA screening, surveillance, and intervention. Relevant women-specific parameters were obtained from sources including systematic literature reviews, national registry or administrative databases, major AAA surgery trials, and UK National Health Service reference costs. FINDINGS: AAA screening for women, as currently offered to UK men (at age 65 years, with an AAA diagnosis at an aortic diameter of ≥3·0 cm, and elective repair considered at ≥5·5cm) gave, over 30 years, an estimated incremental cost-effectiveness ratio of £30 000 (95% CI 12 000-87 000) per quality-adjusted life year gained, with 3900 invitations to screening required to prevent one AAA-related death and an overdiagnosis rate of 33%. A modified option for women (screening at age 70 years, diagnosis at 2·5 cm and repair at 5·0 cm) was estimated to have an incremental cost-effectiveness ratio of £23 000 (9500-71 000) per quality-adjusted life year and 1800 invitations to screening required to prevent one AAA-death, but an overdiagnosis rate of 55%. There was considerable uncertainty in the cost-effectiveness ratio, largely driven by uncertainty about AAA prevalence, the distribution of aortic sizes for women at different ages, and the effect of screening on quality of life. INTERPRETATION: By UK standards, an AAA screening programme for women, designed to be similar to that used to ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| تدمد: | 0140-6736 |
| العلاقة: | Lancet; http://hdl.handle.net/10044/1/61628Test; https://dx.doi.org/10.1016/S0140-6736Test(18)31222-4; RG77721 |
| DOI: | 10.1016/S0140-6736(18)31222-4 |
| الإتاحة: | https://doi.org/10.1016/S0140-6736Test(18)31222-4 http://hdl.handle.net/10044/1/61628Test |
| حقوق: | © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 Licence (https://creativecommons.org/licenses/by-nc-nd/4.0Test/) |
| رقم الانضمام: | edsbas.160C42B1 |
| قاعدة البيانات: | BASE |
| تدمد: | 01406736 |
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| DOI: | 10.1016/S0140-6736(18)31222-4 |