Screening individuals with intracranial aneurysms for abdominal aortic aneurysms is cost-effective based on estimated coprevalence

Benjamin Z. Ball, Boxiang Jiang, Prachi Mehndiratta, George J. Stukenborg, Gilbert R. Upchurch, James F Meschia, Bradford B. Worrall, Andrew M. Southerland

Research output: Contribution to journalReview article

3 Scopus citations

Abstract

Objective Aneurysm rupture is a major cause of morbidity and mortality, and evidence suggests shared risk for both abdominal aortic aneurysms (AAAs) and intracranial aneurysms (IAs). We hypothesized that screening for AAA in patients with known IA is cost-effective. Methods We used a decision tree model to compare costs and outcomes of AAA screening vs no screening in a hypothetical cohort of patients with IA. We measured expected outcomes using quality-adjusted life-years (QALYs) and the incremental cost-effectiveness ratio (ICER). We performed a Monte Carlo simulation and additional sensitivity analyses to assess the effects of ranging base case variables on model outcomes and identified thresholds where a decision alternative dominated the model (both less expensive and more effective than the alternative). Results In our base case analysis, screening for AAA provided an additional 0.17 QALY (2.5-97.5 percentile: 0.11-0.27 QALY) at a saving of $201 (2.5-97.5 percentile: $−127 to $896). This yielded an ICER of $−1150/QALY (2.5-97.5 percentile: $−4299 to $6374/QALY), that is, screening saves $1150 per QALY gained. Conclusions Based on this model, screening for AAA in individuals with IA is cost-effective at an ICER of $1150/QALY, well below accepted societal thresholds estimated at $60,000/QALY. Cost-effectiveness of cross-screening in these populations is sensitive to aneurysm coprevalence and risk of rupture. Further prospective study is warranted to validate this finding.

Original languageEnglish (US)
Pages (from-to)811-818.e3
JournalJournal of Vascular Surgery
Volume64
Issue number3
DOIs
StatePublished - Sep 1 2016

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Screening individuals with intracranial aneurysms for abdominal aortic aneurysms is cost-effective based on estimated coprevalence'. Together they form a unique fingerprint.

  • Cite this

    Ball, B. Z., Jiang, B., Mehndiratta, P., Stukenborg, G. J., Upchurch, G. R., Meschia, J. F., Worrall, B. B., & Southerland, A. M. (2016). Screening individuals with intracranial aneurysms for abdominal aortic aneurysms is cost-effective based on estimated coprevalence. Journal of Vascular Surgery, 64(3), 811-818.e3. https://doi.org/10.1016/j.jvs.2016.05.065