Feasibility And Efficiency Study Of A Population-Based Abdominal Aortic Aneurysm Screening Program In Men And Women In Spain.

Abstract Introduction Based on current evidence, one-time screening for abdominal aortic aneurysm (AAA) in men using ultrasound evaluation reduces mortality related to AAA rupture and is considered cost-effective, even though all-cause mortality reduction still remains in question. In Spain there is no population screening program for AAA, so the aim of our study is to perform a pilot population screening program in our area to assess feasibility and efficiency of an AAA screening program for men and women. Materials And Methods A population AAA screening pilot program was performed in a Barcelona area including 400000 inhabitants. According to inclusion criteria, 4730 individuals aged 65 at the moment of the trial were invited for screening (2089 men and 2641 women). Primary care doctors, trained in duplex ultrasound abdominal evaluations, performed an abdominal aortic measurement. Individuals with a previous diagnosis of AAA, limited life expectancy or wrong contact data were excluded. Participation data, aortic diameters, AAA prevalence and related cardiovascular risk factors were analyzed. Results were used in a cost-utility model to assess efficiency of the screening program. Results Participation was 50.3% in men and 44% in women. 11 patients were excluded because of previously diagnosed AAA. 5 new asymptomatic AAA were detected in 65 years old men (0.5% prevalence), all being active smokers. When considering patients excluded for previous AAA diagnosis prevalence in 65 years old men reached 1.4%. Global AAA prevalence in smoking men reached 2.67%. No AAA was detected in women. Subaneurysmal aorta prevalence in men was 2.9% (N=29) and in women it was 0.08% (N=2). A cost-utility analysis model on screening versus no screening retrieved 13664€/QALY at a 10 years horizon and 39455€/QALY at a 30 years horizon. Conclusion AAA population-based screening by ultrasound evaluation in Primary Care is logistically feasible in our area. Despite of that, AAA prevalence is lower than expected in men, and null in women. Cost-utility model results indicate that a local AAA screening program is only efficient in a 30 years' time horizon. Such inefficient results for a population screening make it necessary to consider other strategies such as opportunistic or subgroup screening in our area.