Outcome of the Swedish Nationwide Abdominal Aortic Aneurysm Screening Program
Background—A general abdominal aortic aneurysm (AAA) screening program, targeting 65-year old men, has gradually been introduced in Sweden since 2006 and reached nationwide coverage in 2015. The aim of this study was to determine the outcome of this program.
Methods—Data on number of invited and examined men, screening-detected AAAs, AAAs operated on, and surgical outcome were retrieved from all 21 Swedish counties for the years 2006-2014. AAA-specific mortality data were retrieved from the Swedish Cause of Death Registry. A linear regression analysis was used to estimate the effect on AAA specific mortality among all men ≥65 years for the observed time period. The long-term effects were projected using a validated Markov model.
Results—Of 302,957 men aged 65-years invited, 84% attended. The prevalence of screening detected AAA was 1.5%. After a mean of 4.5 years, 29% of patients with AAA had been operated on, with a 30 day mortality rate of 0.9% (1.3% after open repair and 0.3% after endovascular repair, p<0.001). The introduction of screening was associated with a significant reduction in AAA-specific mortality (mean 4.0% per year of screening, p=0.020). The number needed to screen and the number needed to operate on to prevent one premature death were 667 and 1.5, respectively. With a total population of 9.5 million the Swedish national AAA-screening program was predicted to annually prevent 90 premature deaths from AAA, and to gain 577 quality adjusted life-years (QALYs). The incremental cost-efficiency ratio (ICER) was estimated to be €7770 per QALY.
Conclusions—Screening 65-year old men for AAA is an effective preventive health-measure, and is highly cost-effective in a contemporary setting. These findings confirm the results from earlier RCTs and model studies in a large population-based setting, of importance for future health-care decision-making.
- Received March 2, 2016.
- Revision received July 21, 2016.
- Accepted August 5, 2016.