期刊
BRITISH MEDICAL JOURNAL
卷 338, 期 -, 页码 -出版社
B M J PUBLISHING GROUP
DOI: 10.1136/bmj.b2307
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资金
- Medical Research Council [G0601031, U.1052.00.001]
- MRC [MC_EX_G0601031] Funding Source: UKRI
- Medical Research Council [MC_EX_G0601031] Funding Source: researchfish
Objectives To assess whether the mortality benefit from screening men aged 65-74 for abdominal aortic aneurysm decreases over time, and to estimate the long term cost effectiveness of screening. Design Randomised trial with 10 years of follow-up. Setting Four centres in the UK. Screening and surveillance was delivered mainly in primary care settings, with follow-up and surgery offered in hospitals. Participants Population based sample of 67 770 men aged 65-74. Interventions Participants were individually allocated to invitation to ultrasound screening (invited group) or to a control group not offered screening. Patients with an abdominal aortic aneurysm detected at screening underwent surveillance and were offered surgery if they met predefined criteria. Main outcome measures Mortality and costs related to abdominal aortic aneurysm, and cost per life year gained. Results Over 10 years 155 deaths related to abdominal aortic aneurysm (absolute risk 0.46%) occurred in the invited group and 296 (0.87%) in the control group (relative risk reduction 48%, 95% confidence interval 37% to 57%). The degree of benefit seen in earlier years of follow-up was maintained in later years. Based on the 10 year trial data, the incremental cost per man invited to screening was 100 pound (95% confidence interval 82 pound to 118) pound, leading to an incremental cost effectiveness ratio of 7600 pound (5100 pound to 13 pound 000) per life year gained. However, the incidence of ruptured abdominal aortic aneurysms in those originally screened as normal increased noticeably after eight years. Conclusions The mortality benefit of screening men aged 65-74 for abdominal aortic aneurysm is maintained up to 10 years and cost effectiveness becomes more favourable over time. To maximise the benefit from a screening programme, emphasis should be placed on achieving a high initial rate of attendance and good adherence to clinical follow-up, preventing delays in undertaking surgery, and maintaining a low operative mortality after elective surgery. On the basis of current evidence, rescreening of those originally screened as normal is not justified.
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