Disclaimer
This information collection is a core HTA, i.e. an extensive analysis of one or more health technologies using all nine domains of the HTA Core Model. The core HTA is intended to be used as an information base for local (e.g. national or regional) HTAs.

Abdominal Aorta Aneurysm Screening

AAA Screening compared to not doing anything in the screening of Abdominal Aorta Aneurysm (AAA) in elderly at moderate risk of developing AAA

(See detailed scope below)

HTA Core Model Application for Screening Technologies 1.0
Core HTA
Published
Tom Jefferson (age.na.s, Italy), Nicola Vicari (age.na.s, Italy), Katrine Bjørnebek Frønsdal (NOKC, Norway)
Claudia Wild, LBI-HTA (Health problem and current use); Daniela Pertl and Sophie Brunner-Ziegler, GÖG (Description and technical characteristics); Iñaki Imaz, ISCIII-AETS (Safety); Katrine Frønsdal and Ingvil Sæterdal, NOKC (Clinical effectiveness), Suvi Mäklin and Taru Haula, THL-FINOHTA (Costs and economic evaluation); Gottfried Endel, HVB (Ethical analysis); Kristi Liiv and Raul Kiivet, UTA (Organisational aspects); Anne Lee, Lotte Groth Jensen and Claus Loevschall, SDU/CAST (Social aspects); Ingrid Wilbacher, HVB (Legal aspects)
Agenzia nationale per i servizi sanitari regionali (age.na.s), Italy
Central Denmark (Denmark), GÖG (Austria), HVB (Austria), ISCIII – AETS (Spain), LBI-HTA (Austria), NOKC (Norway), SDU/CAST (Denmark), THL - FINOHTA (Finland), UTA (Estonia)
4.5.2011 15.16.00
31.1.2013 18.04.00
Jefferson T, Vicari N, Frønsdal K [eds.]. Abdominal Aorta Aneurysm Screening [Core HTA], Agenzia nationale per i servizi sanitari regionali (age.na.s), Italy; 2013. [cited 30 June 2022]. Available from: http://corehta.info/ViewCover.aspx?id=106

Abdominal Aorta Aneurysm Screening

<< Collection summaryDescription and technical characteristics of technology >>

Health Problem and Current Use of the Technology

Authors: Pseudo218 Pseudo218, Pseudo73 Pseudo73

Introduction

The following text gives a broad overview of the health problem of AAA (abdominal aortic aneurysm), the screening population and the current use of AAA screening in Europe.

Methodology

Frame

The collection scope is used in this domain.

TechnologyAAA Screening
Description

Population-based systematic abdominal aortic aneurysm (AAA)screening. This includes one single invitation for the whole target population to do one ultrasound scan examination. Purpose of use: Detect abdominal aortic aneurysm in unruptured phase in order to treat those aneurysms with high risk of rupture.

Intended use of the technologyScreening

Screening programme for abdominal aortic aneurysm

Target condition
Abdominal Aorta Aneurysm (AAA)
Target condition description

All men and women aged 64 or more

Target population

Target population sex: Any. Target population age: elderly. Target population group: Possible future health condition.

Target population description

All men and women aged 64 or more

For: All men and women aged 64 or more.

There is some international variance in the prevalence of AAA. In the western countries the prevalence varies between 5 to 10 % for the 65 – 74 years old men.

In Japan the prevalence is 1 % for the same group of men. The prevalence increases with age.

In England the prevalence is 2 % for men aged 50 – 64 year and 12 % for men aged 80 years or older.

In Denmark the prevalence is 4 % for men aged 65 – 69 and 6 % for men aged 70 – 74 years old. The prevalence for women is significant lower than the prevalence for men.

Comparisonnot doing anything
Description

No population-based AAA screening.

This includes incidental detection of AAA without age or sex limitation while performing abdominal ultrasound examinations due to other/unclear clinical indications and various opportunistic AAA-screening practices

Assessment elements

TopicIssue RelevantResearch questions or rationale for irrelevance
A0001Target ConditionWhich disease/health problem/potential health problem will the technology be used for?yesWhich (potential) health problem will be addressed by AAA screening?
A0002Target ConditionWhat, if any, is the precise definition/ characterization of the target disease? Which diagnosis is given to the condition and according to which classification system (e.g. ICD-10)?yesWhat, if any, is the precise definition/ characterization of AAA? Which diagnosis is given to the condition and according to which classification system (e.g. ICD-10)?
A0003Target ConditionWhich are the known risk factors for acquiring the condition?yesWhich are the known risk factors for acquiring AAA?
A0004Target ConditionWhat is the natural course of the condition?yesWhat is the natural course of AAA?
What is the natural course of ruptured AAAs
A0005Target ConditionWhat are the symptoms at different stages of the disease?yesWhat are the symptoms at different stages of AAA?
What is the risk of rupture at different stages of AAA?
A0006Target ConditionWhat is the burden of the condition?yesWhat is the burden of diagnosed AAAs?
What is the burden of ruptured AAAs?
A0009Target ConditionWhat aspects of the burden of disease are targeted by the technology?yesWhat aspects of the burden of disease are affected by AAA screening?
A0007Target PopulationWhat is the target population of the technology?yesWhat is the target population for AAA screening as well as guideline based opportunistic AAA screening in currently active mass screening programs (optionally limited to Europe)?
A0023Target PopulationHow many people belong to the target population?yesHow many people belong to the target population in Europe?
A0011UtilisationHow much is the technology being used?yesWhich countries use AAA screening?
How efficient is AAA screening (target population/actually screened population) in countries with screening programs?
A0012UtilisationWhat kind of variations in use are there across countries/regions/settings?yesWhat kind of variations in the use of screening are there across countries?
What kind of variations in current screening programs exist (mass screening / opportunistic screening)?
A0013Current Management of the ConditionHow is the disease/health condition currently diagnosed or screened?yesHow is the AAA currently screened?
How is the AAA currently diagnosed?
A0014Current Management of the ConditionHow should the condition be diagnosed or screened according to published algorithms/guidelines?yesHow should AAA be diagnosed / screened according to published algorithms/guidelines?
A0015Current Management of the ConditionHow is the condition currently managed?yesHow is the diagnosis of AAA currently managed?
A0016Current Management of the ConditionHow should the condition be managed according to published algorithms/guidelines?yesHow should AAA be managed according to published algorithms/guidelines?
A0017Current Management of the ConditionWhat are the differences in the management for different stages of disease?yesWhat are the differences in the management of diagnosed AAA for different stages of disease?
A0018Current Management of the ConditionWhat are the other evidence-based alternatives to the current technology?yesWhat are the other evidence-based alternatives to AAA screening ?
A0019Life-CycleIn which phase is the development of the technology?yesIn which phase is the development of AAA screening?
A0021Regulatory StatusWhat is the reimbursement status of the technology across countries?yesWhat is the reimbursement status of AAA screening across countries?
A0020Regulatory StatusWhich market authorization status has the technology in other countries, or international authorities?noThis screening does not seem to undergo specific market authorization or approval processes

Methodology description

Information sources

Due to the diversity of the questions addressed in this chapter/domain and the broad focus on the health problem of AAA/abdominal aortic aneurysm, it did not seem appropriate to undertake a systematic search for all questions but rather an extensive hand search for sources covering the different issues.

Hand searches were carried out in Dec 2011 on

  • systematic search for guidelines on/for AAA-screening in Guidelines International Network and hand search
  • hand search within medical textbooks and epidemiological materials for descriptions of health problem, definitions and classifications, risks, natural course and symptoms, burden of disease
  • hand search for citation from peer reviewed literature, tertiary literature and technical literature for additional information on specific questions, complementing the information from medical textbooks, e.g. screening trials
  • EUnetHTA survey on AAA-screening and reimbursement in Europe
Quality assessment tools or criteria

No quality assessment tool were used, but the strategy was to use multiple sources in order to validate individual, possibly biased, sources.

Result cards

Target Condition

Result card for CUR1: "Which (potential) health problem will be addressed by AAA screening?"

View full card
CUR1: Which (potential) health problem will be addressed by AAA screening?
Result

Importance: Critical

Transferability: Completely

Result card for CUR2: "What, if any, is the precise definition/ characterization of AAA? Which diagnosis is given to the condition and according to which classification system (e.g. ICD-10)?"

View full card
CUR2: What, if any, is the precise definition/ characterization of AAA? Which diagnosis is given to the condition and according to which classification system (e.g. ICD-10)?
Result
Comment

Importance: Important

Transferability: Partially

Result card for CUR3: "Which are the known risk factors for acquiring AAA?"

View full card
CUR3: Which are the known risk factors for acquiring AAA?
Result

Importance: Critical

Transferability: Partially

Result card for CUR4: "What is the natural course of AAA?" and CUR22: "What is the natural course of ruptured AAAs"

View full card
CUR4: What is the natural course of AAA?
Result

Importance: Critical

Transferability: Completely

CUR22: What is the natural course of ruptured AAAs
Result

Importance: Unspecified

Transferability: Unspecified

Result card for CUR5: "What are the symptoms at different stages of AAA?" and CUR20: "What is the risk of rupture at different stages of AAA?"

View full card
CUR5: What are the symptoms at different stages of AAA?
Result

Importance: Critical

Transferability: Completely

CUR20: What is the risk of rupture at different stages of AAA?
Result

Importance: Critical

Transferability: Completely

Result card for CUR6: "What is the burden of diagnosed AAAs?" and CUR21: "What is the burden of ruptured AAAs?"

View full card
CUR6: What is the burden of diagnosed AAAs?
Result
Comment

Importance: Critical

Transferability: Partially

CUR21: What is the burden of ruptured AAAs?
Result

Importance: Unspecified

Transferability: Unspecified

Result card for CUR8: "What aspects of the burden of disease are affected by AAA screening?"

View full card
CUR8: What aspects of the burden of disease are affected by AAA screening?
Result

Importance: Unspecified

Transferability: Unspecified

Target Population

Result card for CUR7: "What is the target population for AAA screening as well as guideline based opportunistic AAA screening in currently active mass screening programs (optionally limited to Europe)?"

View full card
CUR7: What is the target population for AAA screening as well as guideline based opportunistic AAA screening in currently active mass screening programs (optionally limited to Europe)?
Result

Importance: Unspecified

Transferability: Unspecified

Result card for CUR19: "How many people belong to the target population in Europe?"

View full card
CUR19: How many people belong to the target population in Europe?
Result

Importance: Unspecified

Transferability: Unspecified

Utilisation

Result card for CUR9: "Which countries use AAA screening?" and CUR23: "How efficient is AAA screening (target population/actually screened population) in countries with screening programs?"

View full card
CUR9: Which countries use AAA screening?
Result

Importance: Unspecified

Transferability: Unspecified

CUR23: How efficient is AAA screening (target population/actually screened population) in countries with screening programs?
Result

Importance: Unspecified

Transferability: Unspecified

Result card for CUR10: "What kind of variations in the use of screening are there across countries?" and CUR24: "What kind of variations in current screening programs exist (mass screening / opportunistic screening)?"

View full card
CUR10: What kind of variations in the use of screening are there across countries?
Result

Importance: Unspecified

Transferability: Unspecified

CUR24: What kind of variations in current screening programs exist (mass screening / opportunistic screening)?
Result

Importance: Unspecified

Transferability: Unspecified

Current Management of the Condition

Result card for CUR11: "How is the AAA currently screened?" and CUR25: "How is the AAA currently diagnosed?"

View full card
CUR11: How is the AAA currently screened?
Result

Importance: Unspecified

Transferability: Unspecified

CUR25: How is the AAA currently diagnosed?
Result

Importance: Unspecified

Transferability: Unspecified

Result card for CUR12: "How should AAA be diagnosed / screened according to published algorithms/guidelines?"

View full card
CUR12: How should AAA be diagnosed / screened according to published algorithms/guidelines?
Result

Importance: Unspecified

Transferability: Unspecified

Result card for CUR13: "How is the diagnosis of AAA currently managed?"

View full card
CUR13: How is the diagnosis of AAA currently managed?
Result

Importance: Unspecified

Transferability: Unspecified

Result card for CUR14: "How should AAA be managed according to published algorithms/guidelines?"

View full card
CUR14: How should AAA be managed according to published algorithms/guidelines?
Result

Importance: Unspecified

Transferability: Unspecified

Result card for CUR15: "What are the differences in the management of diagnosed AAA for different stages of disease?"

View full card
CUR15: What are the differences in the management of diagnosed AAA for different stages of disease?
Result

Importance: Unspecified

Transferability: Unspecified

Result card for CUR16: "What are the other evidence-based alternatives to AAA screening ?"

View full card
CUR16: What are the other evidence-based alternatives to AAA screening ?
Result

Importance: Unspecified

Transferability: Unspecified

Life-Cycle

Result card for CUR17: "In which phase is the development of AAA screening?"

View full card
CUR17: In which phase is the development of AAA screening?
Result

Importance: Unspecified

Transferability: Unspecified

Regulatory Status

Result card for CUR18: "What is the reimbursement status of AAA screening across countries?"

View full card
CUR18: What is the reimbursement status of AAA screening across countries?
Result

Importance: Unspecified

Transferability: Unspecified

References

{1} Ouriel K, Green RM, Donayre C, Shortell CK, Elliott J, DeWeese JA. An evaluation of new methods of expressing aortic aneurysm size: relationship to rupture. J Vasc Surg. 1992 Jan;15(1):12-8; discussion 9-20.

{2} Sakalihasan N, Limet R, Defawe OD. Abdominal aortic aneurysm. Lancet. 2005 Apr 30-May 6;365(9470):1577-89.

{3} Michel JB, Martin-Ventura JL, Egido J, Sakalihasan N, Treska V, Lindholt J, et al. Novel aspects of the pathogenesis of aneurysms of the abdominal aorta in humans. Cardiovascular research. 2011 Apr 1;90(1):18-27.

{4} Mohler ER. Patient information: Abdominal aortic aneurysm 2011 {cited 2011-12-16}; Available from: http://www.uptodate.com/contents/patient-information-abdominal-aortic-aneurysm

{5} Fowkes G. Peripheral Vascular Disease - Health Care Needs Assessment - Third Series. 2007 {cited 2011-12-22; Available from: http://www.hcna.bham.ac.uk/documents/09_HCNA3_D2.pdf

{6} Bown MJ, Sutton AJ,BellPR,Sayers RD.A meta-analysis of 50 years of ruptured abdominal aortic aneurysm repair. The British journal of surgery. 2002 Jun;89(6):714-30.

{7} Greenhalgh RM, Brown LC, Kwong GP, Powell JT, Thompson SG. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet. 2004 Sep 4-10;364(9437):843-8.

{8} World Health Organisation. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010. 2010 {cited 2011-12-20}; Available from: http://apps.who.int/classifications/icd10/browse/2010/en#/I71

{9} National Library of Medicine. Aortic Aneurysm, Abdominal. 1993 {cited 2011-12-30}; Available from: http://www.ncbi.nlm.nih.gov/mesh/68017544

{10} Blanchard JF, Armenian HK, Friesen PP. Risk factors for abdominal aortic aneurysm: results of a case-control study. American journal of epidemiology. 2000 Mar 15;151(6):575-83.

{11} Kent KC, Zwolak RM, Egorova NN, Riles TS, Manganaro A, Moskowitz AJ, et al. Analysis of risk factors for abdominal aortic aneurysm in a cohort of more than 3 million individuals. J Vasc Surg. 2011 Sep;52(3):539-48.

{12} Robbins SL, Cotran RS, Kumar V, Schoen FJ. Robbins pathologic basis of disease. 5th ed/ed.Philadelphia;London: Saunders 1994.

{13} UKNational Screening Committee. NHS Abdominal Aortic Aneurysm (AAA) Screening Programme - Information for Health Professionals. 2010 {cited 2011-12-21; Available from: http://aaa.screening.nhs.uk/getdata.php?id=219

{14} Scott RA, Bridgewater SG, Ashton HA. Randomized clinical trial of screening for abdominal aortic aneurysm in women. The British journal of surgery. 2002 Mar;89(3):283-5.

{15} Ashton HA, Gao L, Kim LG, Druce PS, Thompson SG, Scott RA. Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms. The British journal of surgery. 2007 Jun;94(6):696-701.

{16} Lindholt JS, Juul S, Fasting H, Henneberg EW. Screening for abdominal aortic aneurysms: single centre randomised controlled trial. BMJ (Clinical research ed. 2005 Apr 2;330(7494):750.

{17} Norman PE, Jamrozik K, Lawrence-Brown MM,LeMT, Spencer CA, Tuohy RJ, et al. Population based randomised controlled trial on impact of screening on mortality from abdominal aortic aneurysm. BMJ (Clinical research ed. 2004 Nov 27;329(7477):1259.

{18} Fleming C, Whitlock EP, Beil TL, Lederle FA. Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2005 Feb 1;142(3):203-11.

{19} Cosford PA, Leng GC. Screening for abdominal aortic aneurysm. Cochrane Database Syst Rev. 2007(2):CD002945.

{20} Lindholt JS, Sorensen J, Sogaard R, Henneberg EW. Long-term benefit and cost-effectiveness analysis of screening for abdominal aortic aneurysms from a randomized controlled trial. The British journal of surgery. 2010 Jun;97(6):826-34.

{21} Lindholt JS, Juul S, Henneberg EW, Fasting H. Is screening for abdominal aortic aneurysm acceptable to the population? Selection and recruitment to hospital-based mass screening for abdominal aortic aneurysm. Journal of public health medicine. 1998 Jun;20(2):211-7.

{22} O'Kelly TJ, Heather BP. General practice-based population screening for abdominal aortic aneurysms: a pilot study. The British journal of surgery. 1989 May;76(5):479-80.

{23} Scott RA, Tisi PV, Ashton HA, Allen DR. Abdominal aortic aneurysm rupture rates: a 7-year follow-up of the entire abdominal aortic aneurysm population detected by screening. J Vasc Surg. 1998 Jul;28(1):124-8.

{24} Mastracci TM, Cina CS. Screening for abdominal aortic aneurysm inCanada: review and position statement of the Canadian Society for Vascular Surgery. J Vasc Surg. 2007 Jun;45(6):1268-76.

{25} U.S.Preventive Services Task Force. Screening for abdominal aortic aneurysm: recommendation statement. Ann Intern Med. 2005 Feb 1;142(3):198-202.

{26} Kent KC, Zwolak RM, Jaff MR, Hollenbeck ST, Thompson RW, Schermerhorn ML, et al. Screening for abdominal aortic aneurysm: a consensus statement. J Vasc Surg. 2004 Jan;39(1):267-9.

{27} United KingdomSmall Aneurysm Trial Participants. Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. TheNew Englandjournal of medicine. 2002 May 9;346(19):1445-52.

{28} Stevenson. Essential Elements in Developing an Abdominal Aortic Aneurysm (AAA) Screening and Surveillance Programme. 2011 {cited 2011-09-19}; Available from: http://aaa.screening.nhs.uk/getdata.php?id=221

{29} Chaikof EL, Brewster DC, Dalman RL, Makaroun MS, Illig KA,SicardGA, et al. The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg. 2009 Oct;50(4 Suppl):S2-49.

<< Collection summaryDescription and technical characteristics of technology >>