scholarly journals Commentary on ‘Cost-effectiveness of Screening for Abdominal Aortic Aneurysm in Combination with Medical Intervention in Patients with Small Aneurysms’

2016 ◽  
Vol 51 (6) ◽  
pp. 774 ◽  
Author(s):  
J.S. Brunkwall ◽  
S.K. Brunkwall
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Cost Effectiveness ◽  
Aortic Aneurysm ◽  
Medical Intervention ◽  
Abdominal Aortic ◽  
Small Aneurysms

scholarly journals Discrete Event Simulation for Decision Modeling in Health Care: Lessons from Abdominal Aortic Aneurysm Screening

2018 ◽  
Vol 38 (4) ◽  
pp. 439-451 ◽  
Author(s):  
Matthew J. Glover ◽  
Edmund Jones ◽  
Katya L. Masconi ◽  
Michael J. Sweeting ◽  
Simon G. Thompson ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Cost Effectiveness ◽  
Aortic Aneurysm ◽  
Decision Problem ◽  
Markov Models ◽  
Discrete Event ◽  
Cost Effective ◽  
Event Simulation ◽  
Abdominal Aortic ◽  
The Uk

Markov models are often used to evaluate the cost-effectiveness of new healthcare interventions but they are sometimes not flexible enough to allow accurate modeling or investigation of alternative scenarios and policies. A Markov model previously demonstrated that a one-off invitation to screening for abdominal aortic aneurysm (AAA) for men aged 65 y in the UK and subsequent follow-up of identified AAAs was likely to be highly cost-effective at thresholds commonly adopted in the UK (£20,000 to £30,000 per quality adjusted life-year). However, new evidence has emerged and the decision problem has evolved to include exploration of the circumstances under which AAA screening may be cost-effective, which the Markov model is not easily able to address. A new model to handle this more complex decision problem was needed, and the case of AAA screening thus provides an illustration of the relative merits of Markov models and discrete event simulation (DES) models. An individual-level DES model was built using the R programming language to reflect possible events and pathways of individuals invited to screening v. those not invited. The model was validated against key events and cost-effectiveness, as observed in a large, randomized trial. Different screening protocol scenarios were investigated to demonstrate the flexibility of the DES. The case of AAA screening highlights the benefits of DES, particularly in the context of screening studies.

Benefit, Risks and Cost-Effectiveness of Screening for Abdominal Aortic Aneurysm

2010 ◽  
Vol 182 (07) ◽  
pp. 573-580 ◽  
Author(s):  
T. Schmidt ◽  
N. Mühlberger ◽  
I. Chemelli-Steingruber ◽  
A. Strasak ◽  
B. Kofler ◽  
...  
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Cost Effectiveness ◽  
Aortic Aneurysm ◽  
Abdominal Aortic

COST-EFFECTIVENESS OF TARGETED SCREENING FOR ABDOMINAL AORTIC ANEURYSM

2000 ◽  
Vol 16 (1) ◽  
pp. 22-34 ◽  
Author(s):  
Tuomo Johannes Pentikäinen ◽  
Teemu Sipilä ◽  
Pekka Rissanen ◽  
Sari Soisalon-Soininen ◽  
Jarmo Salo
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Cost Effectiveness ◽  
Aortic Aneurysm ◽  
Incremental Cost ◽  
Empirical Studies ◽  
Epidemiological Studies ◽  
Point Estimate ◽  
Abdominal Aortic ◽  
Life Years ◽  
Targeted Screening

Objectives: This article reports a cost-effectiveness analysis of targeted screening for abdominal aortic aneurysm (AAA). A major emphasis was on the estimation of distributions of costs and effectiveness.Methods: We performed a Monte Carlo simulation using C programming language in a PC environment. Data on survival and costs, and a majority of screening probabilities, were from our own empirical studies. Natural history data were based on the literature.Results: Each screened male gained 0.07 life-years at an incremental cost of FIM 3,300. The expected values differed from zero very significantly. For females, expected gains were 0.02 life-years at an incremental cost of FIM 1,100, which was not statistically significant. Cost-effectiveness ratios and their 95% confidence intervals were FIM 48,000 (27,000–121,000) and 54,000 (22,000–∞) for males and females, respectively. Sensitivity analysis revealed that the results for males were stable. Individual variation in life-year gains was high.Conclusions: Males seemed to benefit from targeted AAA screening, and the results were stable. As far as the cost-effectiveness ratio is considered acceptable, screening for males seemed to be justified. However, our assumptions about growth and rupture behavior of AAAs might be improved with further clinical and epidemiological studies. As a point estimate, females benefited in a similar manner, but the results were not statistically significant. The evidence of this study did not justify screening of females.

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