MASS: modelling the long-term cost- effectiveness of a national screening programme for Abdominal Aortic Aneurysm (AAA)
|Funding:||National Screening Committee|
|Collaborators:||Health Economics Research Group, Brunel University; MRC Biostatistics Unit, Cambridge|
In 2002, the MRC funded Multi-centre Aneurysm Screening Study (MASS) Trial published results on the four-year effectiveness and costs of offering a single ultrasound scan for the detection of AAA, to a group of men aged 65-74. Such four-year results were promising, with a cost per life year figure of approximately £28,000. In January 2003, the National Screening Committee, in considering the need for a national AAA screening programme commissioned an additional piece of research to model the long-term (lifetime) costs and effects that would be associated with AAA screening.
The Markov model developed for this work enables calculation of the incremental cost per life year and per quality-adjusted life-year (QALY) associated with AAA screening. The model was constructed so as to enable key issues likely to impact upon the cost-effectiveness of a national AAA screening programme (for example screening of a single age cohort, screening below 65, attendance rates at screening, sensitivity and specificity of tests for AAA detection) to be explored. The model, which is capable of probabilistic sensitivity analysis, was populated using data from a variety of sources including the MASS Trial, and the published literature.
Main Findings: Based upon a 30-year perspective, screening for abdominal aortic aneurysms in elderly men was found to be highly cost-effective at £2320 per life-year gained (95% uncertainty interval: £1600 to £4240). Adjusting life-years for age-specific health-related quality of life produced a figure of £2970 (95%uncertainty interval: £2030 to £5430) per quality-adjusted life-year gained. The additional cost of screening the UK male population is estimated to be £19m per year. In March 2007 the UK National Screening Committee announced that the four UK Health departments could now consider whether to screen elderly men for AAA.
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Kim, LG, Thompson, SG, Briggs, AH, Buxton, MJ, and Campbell, HE (2007). How cost-effective is screening for abdominal aortic aneurysms? J Med Screen 14(1):46-52.
Ashton HA, Buxton MJ, Campbell HE, Day NE, Kim LG, Marteau TM, Scott RAP, Thompson SG on behalf of the Multicentre Aneurysm Screening Study Group (2002). Multicentre Aneurysm Screening Study (MASS): Cost-effectiveness Analysis of Screening for Abdominal Aortic Aneurysms Based on Four Year Results from a Randomised Controlled Trial. BMJ 2002; 325: 1135.