Abstract
Background: The National Health Service (NHS) abdominal aortic aneurysm (AAA) screening programme (NAAASP) in England screens 65-year-old men. The programme monitors those with an aneurysm, and early intervention for large aneurysms reduces ruptures and AAA-related mortality. AAA screening services have been disrupted following COVID-19 but it is not known how this may impact AAA-related mortality, or where efforts should be focussed as services resume.
Methods: We repurposed a previously validated discrete event simulation model to investigate the impact of COVID-19-related service disruption on key outcomes. This model was used to explore the impact of delayed invitation and reduced attendance in men invited to screening. Additionally, we investigated the impact of temporarily suspending scans, increasing the threshold for elective surgery to 7cm and increasing drop-out in the AAA cohort under surveillance, using data from NAAASP to inform the population.
Findings: Delaying invitation to primary screening up to two years had little impact on key outcomes whereas a 10% reduction in attendance could lead to a 2% lifetime increase in AAA-related deaths. In surveillance patients, a 1-year suspension of surveillance or increase in the elective threshold resulted in a 0.4% increase in excess AAA-related deaths (8% in those 5–5.4cm at the start). Longer suspensions or a doubling of drop-out from surveillance would have a pronounced impact on outcomes.
Interpretation: Efforts should be directed towards encouraging men to attend AAA screening service appointments post-COVID-19. Those with AAAs on surveillance should be prioritised as the screening programme resumes, as changes to these services beyond one year are likely to have a larger impact on surgical burden and AAA-related mortality.
| Original language | English |
|---|---|
| Article number | e0253327 |
| Number of pages | 13 |
| Journal | PLoS ONE |
| Volume | 16 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 15 Jun 2021 |
Bibliographical note
Funding Information: This work was supported by core funding from: the UK Medical Research Council (MR/L003120/1), the British Heart Foundation (RG/13/13/30194) and the NIHR Cambridge Biomedical Research Centre (BRC) [The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care]. LGK is funded by the NIHR Blood and Transplant Research Unit in Donor Health and Genomics (NIHR BTRU-2014-10024). SCH is funded by an MRC CARP Fellowship (Mr/T023783/1). https://mrc.ukri.org/ https://www.bhf.org.uk/for-professionals https://cambridgebrc.nihr.ac.uk/ http://www.donorhealth-btru.nihr.ac.uk/. The sponsors and funders played no role in study design. data collection, decision to publish or preparation of the manuscript.Open Access: This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Publisher Copyright: © 2021 Kim et al.
Citation: Kim LG, Sweeting MJ, Armer M, Jacomelli J, Nasim A, Harrison SC (2021) Modelling the impact of changes to abdominal aortic aneurysm screening and treatment services in England during the COVID-19 pandemic. PLoS ONE 16(6): e0253327.
DOI: https://doi.org/10.1371/journal.pone.0253327