A Simple, Cost-Effective Screening Test for Those at Risk for Abdominal Aortic Aneurysms
New York-Presbyterian Weill Cornell Study Reports New Effective Quick Screen Method Warrants Insurance Coverage<br /><br />Filming of Patients/Screenings
Sep 4, 2002
A simple, low-cost ultrasound screening of men over 60 is not only reliably accurate in detecting abdominal aortic aneurysms (AAA) but is cost-effective in increasing quality-adjusted life years (QALYs). That is the finding of physicians from the Division of Vascular Surgery of New York-Presbyterian Hospital-Weill Cornell Medical College, in an article published in the latest issue of the journal Surgery. The authors, led by Dr. K. Craig Kent, Chief of the Division of Vascular Surgery at NewYork-Presbyterian Hospital, conclude that screening for AAA in men over 60 should be covered by insurance plans, including Medicare. At present, no major plan provides for such coverage.
NewYork-Presbyterian's Division of Vascular Surgery has played a leading role in developing the new "Quick Screen" technology, which can be applied to women as well as men.
The aorta is the main artery that brings blood from the heart into the legs. In some individuals the aorta will widen or dilate developing a bulge called an aneurysm. When the aorta becomes too wide, it will rupture like a balloon that is overfilled. Most patients with ruptured aneurysms do not survive.
"The number of patients who present to hospitals with ruptured AAA in the U.S. each year is approximately 15,000," the authors write. Many other patients who have aneurysms die of rupture without ever reaching medical attention. Because of the aging population, and because possible interventions exist, "it is imperative that programs be developed . . . to detect this fatal condition before symptoms occur."
The investigators screened 25 patients with risk factors for AAA. The factors were either a family history of AAA or three or more of the following: age greater than 60 years, current or former smoker, high blood pressure, elevated cholesterol, heart disease, a history of leg bypass surgery, difficulty walking or symptoms related to poor circulation in the legs, and carotid artery disease or stroke.
All of the subjects were evaluated both through a rapid, less-than-five-minute ultrasound, which the authors call a "Quick Screen," and also through a standard abdominal aortic ultrasound, which required, on average, 24 minutes. Seven patients were found to have aneurysms, and the Quick Screen was found to be 100% reliable in detecting the condition, suggesting that this easy and less costly technique can be used to screen patients for aneurysms.
To determine whether screening is cost-effective relative to other medical interventions, the authors used what is known as a Markov decision-analysis model. The measure used by the physicians for evaluating cost-effectiveness is called the "cost per quality of adjusted life year saved." In layman's terms, this is the amount of money that society or insurers need to pay to prolong a patient's life by one year. The "cost per quality of adjusted life year saved" for common interventions, such as heart surgery or mammography screening for breast cancer, are $9,500 and $16,000, respectively. The authors found that the cost-effective ratio for screening for aneurysms was $11,000, making this test as cost-effective as these other commonly used interventions.
These data convincingly demonstrate that this simple and noninvasive test can be useful in saving lives. Moreover, the test is less or equal in expense to that of most common medical interventions that are currently available.
"Our data suggest that all males above the age of 60 should be screened," the authors write. "Women who have a family history of aneurysmal disease should also be screened." If, as they hope, the recommendation is adopted by Medicare and other insurers, the result may be a significant change in routine care for older men and women—and many extended lives.
Besides Dr. Kent, the authors include Drs. Thomas Y. Lee, Peter Korn, Jennifer A. Heller, Sashi Kilaru, Frederick P. Beavers, and Harry L. Bush.