J Korean Med Assoc.  2016 Oct;59(10):804-812. 10.5124/jkma.2016.59.10.804.

Case study of abdominal aortic aneurysm screening programs in other countries and feasibility study of a national screening program for South Korea

Affiliations
  • 1Seoul School of Integrated Sciences & Technologies, Seoul, Korea. sang.soo.lee@medtronic.com
  • 2Division of Vascular & Endovascular Surgery, Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea.

Abstract

Abdominal aortic aneurysm (AAA) is a disease in which the abdominal aorta is swollen to a diameter as large as 3.0cm or even more. Although the symptoms are usually not prominent, it is fatal once it bursts. If AAA is diagnosed early and treated, the majority of deaths from ruptured AAA can be prevented. It is screened for with ultrasonography, which is a fast, cheap and safe diagnosis tool. Most patients can also tolerate the screening well. Several countries are operating national AAA screening programs in efforts to reduce AAA-related deaths. For instance, the Screening Abdominal Aortic Aneurysms Very Efficiently program in the United States and the National Health Service Abdominal Aortic Aneurysm Screening Programme in the United Kingdom are some of the prominent programs currently available. If Korea conducts AAA screening programs for a target population similar to these cases, the cost is estimated to be 25.7 billion Korean won (23.4 million US dollars [USD]). If the target population is extended to males 65 years of age and above with experience smoking more than 5 pack-years of cigarettes, the cost is estimated to be 36.4 billion Korean won (33.1 million US dollars [USD]). However, considering the actual screening rate of the current national cancer screening program, the realistic costs are estimated to be 10.6 billion Korean won (9.7 million US dollars [USD]) and 15.0 billion Korean won (13.7 million US dollars [USD]), respectively. Given the success of AAA screening programs in other countries, it is necessary to introduce a national AAA screening program in Korea.

Keyword

Aortic aneurysm; Abdominal; Screening; Budget impact analysis

MeSH Terms

Aortic Aneurysm, Abdominal*
Early Detection of Cancer
Cost-Benefit Analysis
Great Britain
Health Services Needs and Demand
Humans
Korea*
Male
Mass Screening*
Patient Selection
Program Evaluation
Smoke
Smoking
Tobacco Products
Ultrasonography
United States

Reference

1. Lederle FA, Johnson GR, Wilson SE, Chute EP, Littooy FN, Bandyk D, Krupski WC, Barone GW, Acher CW, Ballard DJ. Prevalence and associations of abdominal aortic aneurysm detected through screening: Aneurysm Detection and Management (ADAM) Veterans Affairs Cooperative Study Group. Ann Intern Med. 1997; 126:441–449.
Article
2. Fukuda S, Watanabe H, Iwakura K, Daimon M, Ito H, Yoshikawa J. AAA Japan Study Investigators. Multicenter investigations of the prevalence of abdominal aortic aneurysm in elderly Japanese patients with hypertension. Circ J. 2015; 79:524–529.
Article
3. Park YJ, Kim N, Kim YW. Investigation of current trend of AAA treatment in Korea. J Korean Surg Soc. 2011; 80:125–130.
Article
4. Gillum RF. Epidemiology of aortic aneurysm in the United States. J Clin Epidemiol. 1995; 48:1289–1298.
Article
5. Centers for Disease Control and Prevention. Deaths from each cause, by 5-year age groups, race, and sex: United States, 2001 [Internet]. Georgia: Centers for Disease Control and Prevention;2002. 2016 Apr 14. Available from: http://www.cdc.gov/nchs/data/statab/mortfinal2001_workI.pdf.
6. Bengtsson H, Bergqvist D. Ruptured abdominal aortic aneurysm: a population-based study. J Vasc Surg. 1993; 18:74–80.
Article
7. Adam DJ, Mohan IV, Stuart WP, Bain M, Bradbury AW. Community and hospital outcome from ruptured abdominal aortic aneurysm within the catchment area of a regional vascular surgical service. J Vasc Surg. 1999; 30:922–928.
Article
8. Heikkinen M, Salenius JP, Auvinen O. Ruptured abdominal aortic aneurysm in a well-defined geographic area. J Vasc Surg. 2002; 36:291–296.
Article
9. Kantonen I, Lepantalo M, Brommels M, Luther M, Salenius JP, Ylonen K. Mortality in ruptured abdominal aortic aneurysms: the Finnvasc Study Group. Eur J Vasc Endovasc Surg. 1999; 17:208–212.
10. Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, van Herwaarden JA, Holt PJ, van Keulen JW, Rantner B, Schlosser FJ, Setacci F, Ricco JB. European Society for Vascular Surgery. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg. 2011; 41:Suppl 1. S1–S58.
Article
11. Kim JY, Jeon YS, Cho SG, Kong E, Jung JE, Park SG, Cho JS, Kim KR, Shin SH, Ahn SI, Cho YU, Kim SJ, Lee KY, Hur YS, Choi SK, Choe YM, Hong KC. Prevalence and characteristics of major vascular diseases of elderly men in the Incheon Area. J Korean Surg Soc. 2010; 78:305–313.
Article
12. Joh JH, Ahn HJ, Park HC. Reference diameters of the abdominal aorta and iliac arteries in the Korean population. Yonsei Med J. 2013; 54:48–54.
Article
13. Heller JA, Weinberg A, Arons R, Krishnasastry KV, Lyon RT, Deitch JS, Schulick AH, Bush HL Jr, Kent KC. Two decades of abdominal aortic aneurysm repair: have we made any progress? J Vasc Surg. 2000; 32:1091–1100.
Article
14. Statistics Korea. 2015 Korea social index: Statistics Korea press release [Internet]. Daejeon: Statistics Korea;2016. 2016 Apr 13. Available from: http://kostat.go.kr/portal/korea/kor_nw/2/1/index.board?bmode=read&aSeq=352215.
15. Prinssen M, Verhoeven EL, Buth J, Cuypers PW, van Sambeek MR, Balm R, Buskens E, Grobbee DE, Blankensteijn JD. Dutch Randomized Endovascular Aneurysm Management (DREAM) trial group. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med. 2004; 351:1607–1618.
Article
16. Lederle FA, Freischlag JA, Kyriakides TC, Padberg FT Jr, Matsumura JS, Kohler TR, Lin PH, Jean-Claude JM, Cikrit DF, Swanson KM, Peduzzi PN. Open Versus Endovascular Repair (OVER) Veterans Affairs Cooperative Study Group. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: a randomized trial. JAMA. 2009; 302:1535–1542.
Article
17. Paravastu SC, Jayarajasingam R, Cottam R, Palfreyman SJ, Michaels JA, Thomas SM. Endovascular repair of abdominal aortic aneurysm. Cochrane Database Syst Rev. 2014; (1):CD004178.
Article
18. Ministry of Health and Welfare. Revision on details about the criteria and method of health reimbursement coverage: Ministry of Health and Welfare Notice 2011-172 [Internet]. Sejong: Ministry of Health and Welfare;2011. 2016 Apr 5. Available from: http://www.mohw.go.kr/front_new/jb/sjb0406ls.jsp?PAR_MENU_ID=03&MENU_ID=030406&page=95.
19. Pasternak RC, Abrams J, Greenland P, Smaha LA, Wilson PW, Houston-Miller N. Task force #1. Identification of coronary heart disease risk: is there a detection gap? J Am Coll Cardiol. 2003; 41:1863–1874.
Article
20. Silverstein MD, Pitts SR, Chaikof EL, Ballard DJ. Abdominal aortic aneurysm (AAA): cost-effectiveness of screening, surveillance of intermediate-sized AAA, and management of symptomatic AAA. Proc (Bayl Univ Med Cent). 2005; 18:345–367.
Article
21. LaRoy LL, Cormier PJ, Matalon TA, Patel SK, Turner DA, Silver B. Imaging of abdominal aortic aneurysms. AJR Am J Roentgenol. 1989; 152:785–792.
Article
22. Wilson JM, Jungner G. Principles and practice of screening for disease: public health papers 34 [Internet]. Geneva: World Health Organization;1968. 2016 Apr 3. Available from: http://apps.who.int/iris/handle/10665/37650.
23. Scott RA, Ashton HA, Kay DN. Abdominal aortic aneurysm in 4237 screened patients: prevalence, development and management over 6 years. Br J Surg. 1991; 78:1122–1125.
Article
24. Ashton HA, Buxton MJ, Day NE, Kim LG, Marteau TM, Scott RA, Thompson SG, Walker NM. Multicentre Aneurysm Screening Study Group. The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet. 2002; 360:1531–1539.
Article
25. Norman PE, Jamrozik K, Lawrence-Brown MM, Dickinson JA. Western Australian randomised controlled trial of screening for abdominal aortic aneurysms [abstract]. Br J Surg. 2003; 90:492.
26. Ferket BS, Grootenboer N, Colkesen EB, Visser JJ, van Sambeek MR, Spronk S, Steyerberg EW, Hunink MG. Systematic review of guidelines on abdominal aortic aneurysm screening. J Vasc Surg. 2012; 55:1296–1304.
Article
27. Centers for Medicare and Medicaid Services. Abdominal aortic aneurysm screening [Internet]. Baltimore: Centers for Medicare and Medicaid Services;2007. 2016 Apr 13. Available from: https://www.medicare.gov/coverage/ab-aortic-aneurysm-screening.html.
28. Lee ES, Pickett E, Hedayati N, Dawson DL, Pevec WC. Implementation of an aortic screening program in clinical practice: implications for the Screen for Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act. J Vasc Surg. 2009; 49:1107–1111.
Article
29. Multicentre Aneurysm Screening Study Group. Multicentre aneurysm screening study (MASS): cost effectiveness analysis of screening for abdominal aortic aneurysms based on four year results from randomised controlled trial. BMJ. 2002; 325:1135.
30. Wanhainen A, Lundkvist J, Bergqvist D, Bjorck M. Cost-effectiveness of different screening strategies for abdominal aortic aneurysm. J Vasc Surg. 2005; 41:741–751.
Article
31. Lee TY, Korn P, Heller JA, Kilaru S, Beavers FP, Bush HL, Kent KC. The cost-effectiveness of a "quick-screen" program for abdominal aortic aneurysms. Surgery. 2002; 132:399–407.
Article
32. Ministry of Health and Welfare. Guidebook of national health screening program in 2016 [Internet]. Sejong: Ministry of Health and Welfare;2016. 2016 Apr 13. Available from: http://www.mohw.go.kr/front_new/jb/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=0329&CONT_SEQ=330317&page=1.
33. Ministry of Health and Welfare. Cancer Control Act [Internet]. Sejong: Ministry of Government Legislation;2016. 2016 Apr 16. Available from: http://www.law.go.kr/engLsSc.do?menuId=0&subMenu=5&query=%EC%95%94%EA%B4%80%EB%A6%AC%EB%B2%95#liBgcolor0.
34. National Cancer Information Center. Cancer information service [Internet]. Goyang: National Cancer Information Center;2013. 2016 Apr 16. Available from: http://www.cancer.go.kr/mbs/cancer/subview.jsp?id=cancer_060104010000.
35. Statistics Korea. Korean statistical information service [Internet]. Seoul: Minwon 24;2016. 2016 Apr 16. Available from: http://rcps.egov.go.kr:8081/ageStat.do?command=month.
36. National Health Insurance Service. 2014 National health screening statistical yearbook [Internet]. Wonju: National Health Insurance Service;2015. 2016 Apr 16. Available from: http://www.nhis.or.kr/menu/boardRetriveMenuSet.xx?menuId=F3328.
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