Outcome of the Swedish Nationwide abdominal aortic aneurysm screening program

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskrift

Abstract

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 the 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 through 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 of age for the observed time period. The long-term effects were projected by 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 1 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. The incremental cost-efficiency ratio was estimated to be €7770 per quality-adjusted life-years. 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 randomized controlled trials and model studies in a large population-based setting of the importance for future healthcare decision making.

Detaljer

Författare
  • Anders Wanhainen
  • Rebecka Hultgren
  • Anneli Linné
  • Marcus Langenskiöld
  • Kristian Smidfelt
  • Martin Björck
  • Sverker Svensjö
  • Linda Lyttkens
  • Ewa Pihl
  • Tomas Wetterling
  • Per Kjellin
  • Ken Eliasson
  • Erik Wellander
  • Azin Narbani
  • Elisabet Skagius
  • Alexandra Hollsten
  • Martin Welander
  • Toste Länne
  • Bibbi Fröst
  • David Korman
  • Sven Erik Persson
  • Birgitta Sigvant
  • Thomas Troëng
  • Markus Palm
  • Eva Ansgarius
  • Nils Peter Gilgen
  • Christina Sjöström
  • Khatereh Djavani Gidlund
  • Peter Danielsson
  • Adam Bersztel
  • Tomas Jonasson
Externa organisationer
  • Uppsala universitet
  • Karolinska Institute
  • Göteborgs universitet
  • Uppsala University Hospital
  • Central Hospital Kristianstad
  • Helsingborg Hospital
  • Örebro University Hospital
  • Linköping University Hospital
  • Linköping University
  • Oskarshamn County Hospital
  • Östersund Hospital
  • Umeå University
  • Södersjukhuset
  • Blekinge County Council
  • Sunderby Hospital
  • Kullbergska County Hospital
  • Gävle Hospital
  • Region Halland
  • Västmanland Hospital
  • Växjö Central Hospital
  • Skåne University Hospital
Forskningsområden

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Kardiologi

Nyckelord

Originalspråkengelska
Sidor (från-till)1141-1148
Antal sidor8
TidskriftCirculation
Volym134
Utgåva nummer16
StatusPublished - 2016 okt 18
PublikationskategoriForskning
Peer review utfördJa
Externt publiceradJa