Cost-effectiveness of the National Health Service abdominal aortic aneurysm screening programme in England
Cost-effectiveness of the National Health Service abdominal aortic aneurysm screening programme in England
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DOI：
10.1002/bjs.9528
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发表时间：
2014-07-01
影响因子：
9.6
通讯作者：
Buxton, M. J.
中科院分区：
文献类型：
--
作者：
Glover, M. J.;Kim, L. G.;Buxton, M. J.
背景：英国于2009年开始实施65岁男性国家卫生服务腹主动脉瘤（AAA）筛查计划（NAAASP）。支持其引入的证据基础的一个重要因素是筛查的长期成本效益的经济模型，该模型主要基于多中心动脉瘤筛查研究（MASS）随机试验的4年随访数据。考虑到早期的表现参数，特别是在NAAASP中观察到的较低的AAA患病率，人们对这一成本效益结论是否仍然成立表示关注。方法：对已发表的模型进行调整和更新，以反映当前的最佳证据。它被重新校准以反映来自MASS的10年随访数据；重新估计了主要成本参数，以反映当前的做法；并结合了最近meta分析中更可靠的AAA生长和破裂率估计，以及NAAASP中观察到的关键参数（出勤率、AAA患病率和大小分布）。结果：修订和更新的模型产生了长期增量成本效益的估计，每生命年增加5758磅（95%置信区间4285磅至7410磅）磅，或每质量调整生命年（QALY）增加7370磅（5467磅至9443磅）磅。结论：尽管更新的参数，特别是成本的增加和AAA患病率的降低，增加了每个QALY的成本，但最新的模型提供了证据，表明目前在英国实施的AAA筛查仍然具有很高的成本效益。
Background: Implementation of the National Health Service abdominal aortic aneurysm (AAA) screening programme (NAAASP) for men aged 65 years began in England in 2009. An important element of the evidence base supporting its introduction was the economic modelling of the long-term cost-effectiveness of screening, which was based mainly on 4-year follow-up data from the Multicentre Aneurysm Screening Study (MASS) randomized trial. Concern has been expressed about whether this conclusion of cost-effectiveness still holds, given the early performance parameters, particularly the lower prevalence of AAA observed in NAAASP.Methods: The existing published model was adjusted and updated to reflect the current best evidence. It was recalibrated to mirror the 10-year follow-up data from MASS; the main cost parameters were re-estimated to reflect current practice; and more robust estimates of AAA growth and rupture rates from recent meta-analyses were incorporated, as were key parameters as observed in NAAASP (attendance rates, AAA prevalence and size distributions).Results: The revised and updated model produced estimates of the long-term incremental cost-effectiveness of 5758 pound (95 per cent confidence interval 4285 pound to 7410) pound per life-year gained, or 7370 pound (5467 pound to 9443) pound per quality-adjusted life-year (QALY) gained.Conclusion: Although the updated parameters, particularly the increased costs and lower AAA prevalence, have increased the cost per QALY, the latest modelling provides evidence that AAA screening as now being implemented in England is still highly cost-effective.