• Ann. Intern. Med. · May 2007

    Randomized Controlled Trial Multicenter Study

    A sustained mortality benefit from screening for abdominal aortic aneurysm.

    • Lois G Kim, R Alan P Scott, Hilary A Ashton, Simon G Thompson, and Multicentre Aneurysm Screening Study Group.
    • Institute of Public Health, Cambridge, United Kingdom, and St. Richard's Hospital, Chichester, United Kingdom. lois.kim@mrc-bsu.cam.ac.uk
    • Ann. Intern. Med. 2007 May 15; 146 (10): 699-706.

    BackgroundLonger-term mortality benefit and cost-effectiveness for abdominal aortic aneurysm (AAA) screening are uncertain.ObjectiveTo estimate the benefits, in terms of AAA-related and all-cause mortality, and cost-effectiveness of ultrasonography screening for AAA in a group that was invited to screening compared with a group that was not invited at a mean 7-year follow-up.DesignRandomized trial.Setting4 centers in the United Kingdom.PatientsPopulation-based sample of 67,770 men age 65 to 74 years.InterventionPatients with an AAA detected at screening had surveillance and were offered surgery after predefined criteria were met.MeasurementsMortality data were obtained after flagging on the national database. Unit costs obtained from large samples were applied to individual event data for the cost analysis.ResultsThe hazard ratio was 0.53 (95% CI, 0.42 to 0.68) for AAA-related mortality in the group invited for screening. The rupture rate in men with normal results on initial ultrasonography has remained low: 0.54 rupture (CI, 0.25 to 1.02 ruptures) per 10 000 person-years. In terms of all-cause mortality, the observed hazard ratio was 0.96 (CI, 0.93 to 1.00). At the 7-year follow-up, cost-effectiveness was estimated at $19 500 (CI, $12,400 to $39,800) per life-year gained based on AAA-related mortality and $7600 (CI, $3300 to infinity) per life-year gained based on all-cause death. (All values are reported in U.S. dollars [U.K. 1 pound sterling = U.S. $1.58]).LimitationInclusion of deaths from aortic aneurysm at an unspecified site, which may include some thoracic aortic aneurysms, may have underestimated the treatment effect.ConclusionsThese results from a large, pragmatic randomized trial show that the early mortality benefit of screening ultrasonography for AAA is maintained in the longer term and that the cost-effectiveness of screening improves over time. International Standard Randomized Controlled Trial registration number: ISRCTN37381646.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…