Result card

  • ETH1: Is organised Abdominal Aorta Aneurysm Screening a new, innovative mode of care, an add-on to or modification of a standard mode of care or a replacement of a standard?
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Is organised Abdominal Aorta Aneurysm Screening a new, innovative mode of care, an add-on to or modification of a standard mode of care or a replacement of a standard?

Authors: Gottfried Endel

Internal reviewers: Wilhelm Donner, Scott Goulden, Grace Jennings, Paolo Giorgi Rossi, Ingrid Wilbacher, Claudia Wild

Analysing the question shows that the main issue is in “organised population” screening (see PICO question). This implies the responsibility of the healthcare system (authority) for a recommendation. In most settings the “standard mode of care” means AAAs are found by accident or at a symptomatic stage. Healthcare providers may counsel individuals at high risk but there is no strong guidance and therefore high variability can be assumed.

  • Respect for autonomy: the standard mode of care as well as organised population screening meets this criterion.
  • Non-maleficence: the standard mode of care as well as an organised population screening meets this criterion. In an organised programme quality assurance and outcome evaluation should provide a higher degree of fulfilment. The organised programme with a definition of those eligible for screening reduces “waste of resources” for those at low risk. It could harm people outside the target group by reducing access to this preventive care intervention.
  • Beneficence: balancing risks and cost with potential benefits can only be done at the national or local level (information on cost is national or local). To balance risks and potential benefits without regard to costs, the first step is to decide whether to look at the risks of ultrasound alone or – in the case of a positive finding – to consider the risks and decision problems of the subsequent chain of diagnostics and potential interventions. This will be done in the domain summary.
  • Justice: looking at the healthcare system as an SSGI the dimension of justice gets a low value in the standard mode of care. Organised screening dramatically increases the value of the justice domain.

The AAA screening survey (see current use domain) shows that only Sweden provides organised AAA screening programme. Lithuania describes the situation as an opportunistic one. The description resembles the answer of Spain. In CUR7 the UK NHS is cited as having an organised screening tool. In most countries organised population-based screening would be a new proposal.

Ultrasound examinations of the abdomen are well established in all healthcare systems. The new items therefore would be the

  • recommendation (and information) by the “health authority”
  • definition of the target group (with an invitation system)
  • evaluation of quality and outcome

As proposed in the section on quality assessment tools and criteria for this question a score using the four ethical dimensions should be collected.

The general approach on the EU level has to be put into operation at the local level. This could be done using an interactive participatory approach to HTA.

  • Respect for autonomy: the standard mode of care as well as organised population screening meets this criterion.
  • Non-maleficence: the standard mode of care as well as organised population screening meets this criterion. In an organised programme quality assurance and outcome evaluation should provide a higher degree of fulfilment. The organised programme with a definition of those eligible for screening reduces “waste of resources” for those at low risk. It could harm people outside the target group by reducing access to this preventive care intervention.
  • Beneficence: balancing risks and cost with potential benefits can only be done at the local level (information on cost is local). To balance risks and potential benefits without regard to costs, the first step is to decide, whether to look at the risks of ultrasound alone or – in the case of a positive finding – to consider the risks and decision problems of the subsequent chain of diagnostics and potential interventions. This will be done in the domain summary.
  • Justice: Looking at the healthcare system as a SSGI the dimension of justice gets a low value in the standard mode of care. Organised screening dramatically increases the value of the justice domain.
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Endel G Result Card ETH1 In: Endel G Ethical analysis In: 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