Although ultrasound screening for abdominal aortic aneurysm (AAA) is a well-established strategy in men over 65 years of age, its value in women remains controversial because of the lower prevalence of the disease, despite the higher rupture rate when it does occur. This systematic review aimed to evaluate whether AAA screening in women is cost-effective, both in the general population and in higher-risk groups.
The primary endpoint was the cost-effectiveness of screening, expressed as the incremental cost-effectiveness ratio per quality-adjusted life year (ICER/QALY). Nine studies were included (one prospective cohort and eight economic simulation models), mainly from Europe and North America, evaluating AAA screening strategies in women aged 65 years or older. The prevalence of AAA in this population ranged from 0.004% to 1.15%.
In most studies, systematic screening of all women was not found to be a cost-effective strategy, mainly because of the low prevalence of the disease and the limited absolute benefit achieved.
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In contrast, two studies demonstrated that targeted screening of women who smoke was significantly more cost-effective, particularly when focused on those with a higher genetic risk of developing an abdominal aortic aneurysm. In addition, a Canadian model showed that, among women aged 75 years, screening reduced AAA-related mortality by 0.14% and was considered cost-effective in 90% of the simulations performed.
Conclusion: Targeted abdominal aortic aneurysm screening in high-risk women may be cost-effective
Current evidence does not support systematic AAA screening in all women older than 65 years. However, it suggests that a selective screening strategy targeting women who smoke or those with a high cardiovascular or genetic risk could represent a cost-effective alternative.
Original Title: Systematic Review on the Cost Effectiveness of Abdominal Aortic Aneurysm Screening in Women.
