Authors' objectives:

Evaluation of mass screening for AAA in at risk groups, and applicability in the National Health Service.

Authors' results and conclusions: The bibliographical search led to the selection of one systematic review, one meta-analysis and seven retrospective articles that fulfilled the selection criteria that had been applied. The review and the meta-analysis analyzed a total of 36 studies, being the following the most important ones due to their design (multicentric) and participants’ number: Wester (Australia), participation of 41,000 men between 65-79 years; Chichester (United Kingdom), 15,775 individuals, 6,433 men and 9,342 women aged between 60-80 years; Viborg (Denmark), a total of 12,639 men of ages among 64-73 years and finally; MASS (United Kingdom), 67,800 men, aged between 65-74 years. The ultrasound was the method of screening used by all of the studies, defining the aneurysm as a dilation with a diameter ≥ 3 cm. The other seven articles not included in the review or the meta-analysis, also used the ultrasound test for screening and defined the AAA like the previous authors. The majority of these studies were of a retrospective design and were founded on some of the previous studies included in the systematic review. The greatest age range used in the studies was between 64-74 years. The current meta-analysis carried out using the results of the later studies does not modify the conclusions obtained in the previous systematic review and meta-analysis undertaken by the Task Force. The economic evaluation search yielded a total of 222 abstracts. From these, 24 were selected to be read at full text, fulfilling the selection criteria only 13 of them. Most of the works were European (10/13). The most recent studies present the results in AVAG or AVAC, whereas the studies published before the year 2000 only give results in terms of costs.The applicability in the National System of Health was assessed by a theoretical simulation of a program for AAA screening in the Galician Autonomous Community (Spain), where the results advise on the carrying out of a screening, since approximately 40-42 lives would be saved annually and the work load could be assumed by the professionals.

Authors' recommendations: There is ample scientific evidence available of high quality. The studies are generally on masculine population, and they all undertake the screening using the abdominal ultrasound test. The results of the studies show that screening for AAA in masculine population between 65-75 years of age decreases the mortality associated with the AAA, as well as the following up of AAA of 3-5 cm. As the follow up time increases there is a decrease in the number of men to screen and an increase in the number of life-years gained. The treatment by means of open surgery has a lower mortality when the surgery is programmed but not when it is carried out in an urgent way. It is recommended the mass screening for AAA in men 65-75 years of age carried out by means of abdominal ultrasound. The screening in at risk groups such as: smoking women, men and women older than 50 years with a history of an AAA in first grade family. It is recommend the following up of patients when the AAA is ≥ 3 cm and the treatment with open surgery or EVAR if AAA is at 5-5.5 cm, it presents a growth bigger than 1 cm/year, and/or when the patient presents symptoms.

Authors' methods: Systematic Review

Project Status: Completed

URL for project: http://avalia-t.sergas.es/

Year Published: 2008

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Scientific Advice Unit, avalia-t; The Galician Health Knowledge Agency (ACIS)

Contact Address: Conselleria de Sanidade, Xunta de Galicia, San Lazaro s/n 15781 Santiago de Compostela, Spain. Tel: 34 981 541831; Fax: 34 981 542854;

Contact Name: avalia-t@sergas.es

Contact Email: avalia-t@sergas.es

Copyright: Galician Agency for Health Technology Assessment (AVALIA-T)