Evaluating the Cost-Effectiveness of Changes to the Surveillance Intervals in the UK Abdominal Aortic Aneurysm Screening Programme

Michael J. Sweeting*, John Marshall, Matthew Glover, Akhtar Nasim, Matthew J. Bown

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Objectives: To investigate the safety and cost-effectiveness of lengthening the time between surveillance ultrasound scans in the UK Abdominal Aortic Aneurysm (AAA) Screening Programme. Methods: A discrete event simulation model was used to evaluate the cost-effectiveness of AAA screening for men aged 65, comparing current surveillance intervals to 6 alternative surveillance interval strategies that lengthened the time between surveillance scans for 1 or more AAA size categories. The model considered clinical events and costs incurred over a 30-year time horizon and the cost per quality-adjusted life year (QALY). The model adopted the National Health Service perspective and discounted future costs and benefits at 3.5%. Results: Compared with current practice, alternative surveillance strategies resulted in up to a 4% reduction in the number of elective AAA repairs but with an increase of up to 1.6% in the number of AAA ruptures and AAA-related deaths. Alternative strategies resulted in a small reduction in QALYs compared to current practice but with reduced costs. Two strategies that lengthened surveillance intervals in only very small AAAs (3.0-3.9 cm) provided, at a cost-effectiveness threshold of £20 000 per QALY, the highest positive incremental net benefit. There was negligible chance that current practice is the most cost-effective strategy at any threshold below £40 000 per QALY. Conclusions: Lengthening surveillance intervals in the UK Abdominal Aortic Aneurysm Screening Programme, especially for small AAA, can marginally reduce the incremental cost per QALY of the program. Nevertheless, whether the cost savings from refining surveillance strategies justifies a change in clinical practice is unclear.

Original languageEnglish
Pages (from-to)369-376
Number of pages8
JournalValue in Health
Volume24
Issue number3
DOIs
Publication statusPublished - Mar 2021
Externally publishedYes

Bibliographical note

Funding Information:
Funding/Support: Drs Sweeting and Bown and the University of Leicester acknowledge funding from Public Health England / UK National Screening Committee for work undertaken in this manuscript. This work was supported by core funding from the UK Medical Research Council ( MR/L003120/1 ), the British Heart Foundation ( RG/13/13/30194 ; RG/18/13/33946 ), and the National Institute for Health Research (Cambridge Biomedical Research Centre at the Cambridge University Hospitals, and the National Health Services Foundation Trust). Dr Sweeting was funded by the Medical Research Council, the British Heart Foundation, and the National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics ( NIHR BTRU-2014-10024 ).

Funding Information:
Author Contributions: Concept and Design: Sweeting, Marshall, Nasim, Bown, Acquisition of data: Sweeting, Nasim, Bown, Analysis and interpretation of data: Sweeting, Glover, Bown, Drafting of the manuscript: Sweeting, Marshall, Glover, Nasim, Bown, Critical revision of paper for important intellectual content: Sweeting, Marshall, Glover, Nasim, Bown, Statistical analysis: Sweeting, Provision of study materials or patients: Nasim, Obtaining funding: Marshall, Conflict of Interest Disclosures: Dr Sweeting reported receiving personal fees from the UK National Screening Committee during the conduct of this study. Mr Marshall is a paid member of staff at the UK National Screening Committee, who commissioned and funded this work. Dr Bown reported the University of Leicester received payment from the UK National Screening Committee during the conduct of the study. No other disclosures were reported. Funding/Support: Drs Sweeting and Bown and the University of Leicester acknowledge funding from Public Health England/UK National Screening Committee for work undertaken in this manuscript. This work was supported by core funding from the UK Medical Research Council (MR/L003120/1), the British Heart Foundation (RG/13/13/30194; RG/18/13/33946), and the National Institute for Health Research (Cambridge Biomedical Research Centre at the Cambridge University Hospitals, and the National Health Services Foundation Trust). Dr Sweeting was funded by the Medical Research Council, the British Heart Foundation, and the National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics (NIHR BTRU-2014-10024). Role of Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Acknowledgment: This research used the ALICE High Performance Computing Facility at the University of Leicester. Data based on this modeling exercise were previously submitted to the UK National Screening Committee and made publicly available during the consultation period. The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health and Social Care.

Publisher Copyright:
© 2020 ISPOR–The Professional Society for Health Economics and Outcomes Research

Keywords

  • abdominal aortic aneurysm
  • cost-effectiveness analysis
  • decision analytic model screening
  • discrete event simulation
  • microsimulation

Fingerprint

Dive into the research topics of 'Evaluating the Cost-Effectiveness of Changes to the Surveillance Intervals in the UK Abdominal Aortic Aneurysm Screening Programme'. Together they form a unique fingerprint.

Cite this