Result card

  • ECO1: What types of resources are used when delivering population-based screening for Abdominal Aorta Aneurysm, or no systematic screening for AAA (resource use identification)?
Abdominal Aorta Aneurysm Screening
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English
Guidance Resources

What types of resources are used when delivering population-based screening for Abdominal Aorta Aneurysm, or no systematic screening for AAA (resource use identification)?

Authors: Suvi Mäklin, Taru Haula, Kristian Lampe, Jaana Leipälä, Ulla Saalasti-Koskinen

Internal reviewers: Aurora Llanos-Mendez, Sergio Marquez, Urs Brügger, Mark Pletscher, Iñaki Imaz, Sonia García Pérez

Acknowledgments: Information Specialist Jaana Isojärvi (FINOHTA/THL, Finland)

The authors consulted Finnish experts in the field of vascular surgery to help describe the possible systematic organisation of AAA screening and the types and amounts of resources needed.

The types of resources used in AAA screening are also described in other domains: Description and technical characteristics of the technology, Health problem and current use of the technology, and Organisational domain. Please see for example RC-TEC9, RC-TEC10, RC-TEC12, RC-ORG3, RC-ORG7, RC-ORG8 and RC-ORG9. This result card describes the types of resources used when delivering AAA screening in the Finnish healthcare setting, due to the context-specific nature of economic evaluation.

One possible pathway for AAA screening and follow-up is presented in Table 2 (translated from {3}). According to this pathway, for AAA screening and follow-up for small and medium AAAs, the most critical types of resources are ultrasound devices, rooms and trained personnel to do the examinations. For example, sonographers and vascular nursing staff could be trained to perform the screening but where there are positive findings the screened person should have the opportunity to discuss this with a physician. This has been proposed by cardiovascular experts in Finland but it is not in use at the moment. This also differs from the model used in the cost-effectiveness analysis in this domain since no data was available for this type of organisation.

Table 2. The proposed organisation of AAA screening in Finland (Mäklin et al. 2011 {3}).

AAA, mm

Follow-up

Less than 30

No follow-up

30-35

Ultrasound examination every 2 years

36-45

Ultrasound examination every year

Over 45

Ultrasound examination every 6 months and consultation at vascular surgery unit

≥ 50

Consultation at vascular surgery unit

Growth rate >10 mm /year

Consultation at vascular surgery unit

Resources (personnel, rooms) for vascular surgery units would be needed to deal with the increase in consultation visits caused by the screening. Furthermore, the units must also be prepared for an increased need for CT scans to confirm the diagnosis and size of the aneurysm. Finally, screening will significantly increase the need for elective repair of AAA, and all relevant constituent resources should be considered.

The types of resources needed for population-based AAA screening compared with no population-based AAA screening differ in terms of organisation of screening programme. The additional requirements of the screening programme include, for example, identification of the screening population, an invitation system, additional personnel and education of staff needed for screening, and development and distribution of information. The types of resources needed for ultrasound, CT and surgery are similar in both alternatives; only the amounts of resources differ. The numbers of devices, personnel, and relevant premises (examination, operating rooms, emergency department) would, of course, be expected to differ between population-based screening and no screening.

The economic evaluation of population-based AAA screening compared with no population-based AAA screening in this domain is undertaken from the Finnish healthcare payer perspective. As it is not wholly realistic to conduct a cost-effectiveness analysis applicable to all European countries, Finnish data provides a useful example of a base case analysis. The appropriate structure and data inputs of the model are likely to differ from country to country. In addition, the primary investments (training, new equipment etc) needed to start a new screening programme are not included in the cost-effectiveness analysis.

Critical
Partially
Mäklin S et al. Result Card ECO1 In: Mäklin S et al. Costs and economic evaluation 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 28 May 2023]. Available from: http://corehta.info/ViewCover.aspx?id=106

References

3. Mäklin S, Laukontaus S, Salenius J, Romsi P, Roth W, Laitinen R, et al. Vatsa-aortan aneurysman seulonta suomessa [screening for abdominal aortic aneurysms in Finland]. [Screening for abdominal aortic aneurysm in Finland] ed. Helsinki: Terveyden ja hyvinvoinnin laitos; 2011.