Mass screening on abdominal aortic aneurysm in men aged 60 to 65 years in the Netherlands. Impact on life expectancy and cost-effectiveness using a Markov model

Objectives: to predict the costs and effects on life expectancy of an AAA screening programme. Methods: a Markov model was designed to compare the effects of a single screening for a cohort of men 60-65 years with the current no screening strategy. The following health states were distinguished: no AAA, unknown small AAA,follow-up small AAA, unknown large AAA, repaired AAA, rejected large AAA and death. Transition rates between the health states were simulated using cycle times of one year. Transition probabilities were derived from literature and a previous feasibility study. Incremental costs per life year saved were calculated. Sensitivity analyses and discounting for future effects were performed. Results: the expected individual AAA costs for non-screening and AAA screening were 196 euro and 530 euro respectively. A difference of 3.5 months life expectancy was found in favour of screening leading to 1176 euro/life-year gained. Costs increased as compliance fell. With a discount rate of 4% the costs are 2021 euro/life-year gained. Conclusions: one-time ultrasonographic screening for AAA in men aged 60-65 years appears to be cost-effective.