Screening op aneurysma aortae abdominalis: effectiviteit en kosteneffectiviteit

OBJECTIVE: To review the current literature concerning the effectivity and cost-effectiveness of screening for abdominal aortic aneurysm (AAA). DESIGN: Systematic review. METHOD: A review of literature of evaluations of effectivity via meta-analyses and economic evaluations. Results: The short-term meta-analyses showed that screening for AAA leads to a significant reduction of AAA-related mortality. The average absolute risk reduction (ARR) was 0.12%. The long-term meta-analysis also showed a significant reduction of overall mortality. The ARR was in this case almost 1%. The five economic evaluations all resulted in cost-effectiveness ratios below euro 20,000 per quality-adjusted life year (QALY), a used threshold level in the Netherlands. CONCLUSION: Based on the available literature, screening for AAA has appeared to be both effective and cost-effective. However, the economic evaluations did not always take into account the peri- and post-operative mortality and morbidity. Economic evaluations are only useful if all possible outcomes are included in the model. Therefore a good model analysis should be made for the Dutch situation, after which a decision may be taken on a possible pilot study and the optimal design thereof