REVIEW  AORTIC DISEASE Free access

International Angiology 2021 February;40(1):67-76

DOI: 10.23736/S0392-9590.20.04547-2

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Systematic review on abdominal aortic aneurysm screening cost-efficiency and methodological quality assessment

Joan FITÉ ^{1, 2}, Emmanuel GIMENEZ ³, Begoña SOTO ^{1, 2}, Vicente ARTIGAS ^{1, 2}, Jose R. ESCUDERO ^{1, 2}, Sergi BELLMUNT-MONTOYA ^{2, 4} ✉, Mireia ESPALLARGUES ^{3, 5}

¹ Centro de Investigación Biomédica en Red (CIBER) Cardiovascular, Department of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain; ² Universitat Autónoma de Barcelona, Barcelona, Spain; ³ Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Generalitat de Catalunya, Barcelona, Spain; ⁴ Department of Vascular Surgery, Hospital Universitari Vall d’Hebron, University of Barcelona, Barcelona, Spain; ⁵ Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain

INTRODUCTION: Abdominal aortic aneurysm (AAA) is a silent, progressive disease that can lead to death. It is easily diagnosed with noninvasive methods and its routine treatment has excellent results. This creates an optimal situation for population screening programs. The aim of this paper was to assess results and methodological quality of cost-utility studies on screening versus no screening scenarios for AAA to assess future establishment of new AAA screening programs.
EVIDENCE ACQUISITON: A systematic review of efficiency (cost-effectiveness and cost-utility) studies was performed, finally selecting cost-utility studies on AAA screening versus no screening. Papers were selected that dealt with efficiency of screening for AAA according to PICOTS framework and the methodological quality assessed according to the economic evaluation analyses described by Drummond and Caro. Two independent reviewers were involved in the procedure.
EVIDENCE SYNTHESIS: Research retrieved 88 studies. From those, 26 showed cost-effectiveness and cost-utility results. Finally, 10 studies had cost-utility results and suited criteria (published in the last 10 years; time-horizon: 10 years or more) for exhaustive analysis. All publications, except one, showed adequate incremental cost-utility ratios according to different national perspectives. Methodological assessment showed some quality limitations, but the majority of items analyzed were favorably answered after applying the questionnaires.
CONCLUSIONS: Confirmation of the cost-utility results in this revision at a national/regional level should be the basis for the implantation of new national screening programs worldwide. The methodological evaluation applied in this revision is crucial for the corresponding future piggy-back trials to assess routine application of national AAA screening programs.

KEY WORDS: Aortic aneurysm, abdominal; Diagnosis; Review