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 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.