Original Title: Abdominalt aortaaneurisme (AAA) screening av menn i alder 65 år

Authors' objectives: Abdominal aortic aneurysm (AAA) is a weakening of the aortic wall resulting in an abnormal dilatation of the abdominal aortic artery. AAAs bears the risk of rupture, which is a dramatic emergency condition with a high risk of death. In Norway, about 1% of all deaths among men older than 65 years are caused by AAA rupture. In this health technology assessment (HTA) we have assessed the clinical effectiveness of screening all 65-years old men for AAA in Norway by updating an earlier HTA report from the Norwegian Institute of Public Health. We have performed a health economic analysis by adapting into Norwegian setting an existing Markov model elaborated for Sweden.

Authors' results and conclusions: Evidence indicates that AAA screening is beneficial to men aged 65 years, as AAA related mortality is reduced by approximately 50% in the short- and long-term. The documentation shows that AAA screening may decrease overall mortality in the short-term, but the effect is not statistically significant. However, in the long-term the effect is statistically significant. AAA screening decreases the number of urgent operations, while the number of elective repairs increases. Our health economic analysis of AAA screening for men, aged 65, estimates a cost of 154,000 NOK per quality adjusted-life gained (ICER). For each screened cohort, AAA screening will lead to a reduction of 62 AAA-related deaths annually. The estimated budget impact is approximately 20 million NOK per cohort (approx. 28,000 men) per year.

Authors' methods: We performed a literature search for ongoing and completed systematic reviews, HTAs and RCTs in nine databases. As we already knew about the systematic review by Ali et al. from 2016, for which the literature search was conducted in April 2015 (5), we limited our search to publications from 2015 and onwards. In assessing clinical effectiveness, we chose to update findings from an earlier report from the Norwegian Institute of Public Health on the same topic (6) by communicating results from the most recent systematic review identified and assessed to be of high methodological quality. If we had not found a sufficiently updated systematic review of high quality, we planned to search for RCTs with results published after 2015. The search strategies were based on the following PICO (Population, Intervention, Comparator, Outcome): P = all men aged 65 years; I = population based systematic screening (with ultrasound) for abdominal aorta aneurysm (AAA); C = non-population based AAA screening/ no screening; O = AAA related mortality; overall (general or total) mortality; AAA rupture; AAA operations (urgent and elective); 30-days mortality due to AAA operation; quality of life. The strategies included topic and text terms for AAA combined with (AND) topic and text terms for screening. A filter for study design was also included for relevant databases. To conduct a health economic analysis, we adapted an existing Swedish Markov model to reflect the Norwegian setting. The model used effect data from the Multicentre Aneurysm Screening Study (MASS) study (7), while epidemiologic information and costs were collected from Norwegian data sources.

Project Status: Completed

Year Published: 2020

URL for published report: https://www.fhi.no/en/publ/2020/Abdominal-aorta-aneurysm-AAA-screening-of-men-aged-65/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Norway

Organisation Name: Norwegian Institute of Public Health

Contact Address: P.O. Box 222 Skoyen, N-0123, Oslo