Screening for familial abdominal aortic aneurysms (AAA) is widely recommended. To analyze cost-effectiveness of screening for familial AAAs incremental cost-effectiveness (C/E) analysis based on an ultrasound screening among relatives and a decision model of screening program was compared to a baseline situation without systematic screening.
74% (238/322) of first-degree relatives of 150 consecutive AAA patients were screened at HUCH (Helsinki University Central Hospital). Effectiveness and costs of treatment were assessed using the Finnish Hospital Discharge Register and from survival analysis of 1130 AAA patients who underwent elective or emergency surgery in HUCH. To form incremental C/E-ratios the existing clinical practice was compared to a screening program for male siblings. Hypothetical screened and control cohorts of 1000 male relatives were used to create the decision model. Parameters in C/E-analyses were derived from our own data except for growth and rupture rates. A sensitivity analysis was carried out.
The incremental effectiveness in life-years gained by the screening of male siblings was 92 years with incremental C/E-ratio of FIM 33,000 ($6200). According to sensitivity analysis the C/E-ratios were robust for all variables tested.
Screening of male siblings of AAA patients produces incremental life-years at low cost thus screening of male siblings is highly recommended.