Imperial College London

ProfessorJanetPowell

Faculty of MedicineDepartment of Surgery & Cancer

Visiting Professor
 
 
 
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Contact

 

+44 (0)20 8846 7312j.powell

 
 
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Location

 

4N17Charing Cross HospitalCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Sweeting:2018:10.1016/S0140-6736(18)31222-4,
author = {Sweeting, MJ and Masconi, KL and Jones, E and Ulug, P and Glover, MJ and Michaels, JA and Bown, MJ and Powell, JT and Thompson, SG},
doi = {10.1016/S0140-6736(18)31222-4},
journal = {Lancet},
pages = {487--495},
title = {Analysis of clinical benefit, harms, and cost-effectiveness of screening women for abdominal aortic aneurysm.},
url = {http://dx.doi.org/10.1016/S0140-6736(18)31222-4},
volume = {392},
year = {2018}
}

RIS format (EndNote, RefMan)

TY  - JOUR
AB - BACKGROUND: A third of deaths in the UK from ruptured abdominal aortic aneurysm (AAA) are in women. In men, national screening programmes reduce deaths from AAA and are cost-effective. The benefits, harms, and cost-effectiveness in offering a similar programme to women have not been formally assessed, and this was the aim of this study. METHODS: We developed a decision model to assess predefined outcomes of death caused by AAA, life years, quality-adjusted life years, costs, and the incremental cost-effectiveness ratio for a population of women invited to AAA screening versus a population who were not invited to screening. A discrete event simulation model was set up for AAA screening, surveillance, and intervention. Relevant women-specific parameters were obtained from sources including systematic literature reviews, national registry or administrative databases, major AAA surgery trials, and UK National Health Service reference costs. FINDINGS: AAA screening for women, as currently offered to UK men (at age 65 years, with an AAA diagnosis at an aortic diameter of ≥3·0 cm, and elective repair considered at ≥5·5cm) gave, over 30 years, an estimated incremental cost-effectiveness ratio of £30000 (95% CI 12000-87000) per quality-adjusted life year gained, with 3900 invitations to screening required to prevent one AAA-related death and an overdiagnosis rate of 33%. A modified option for women (screening at age 70 years, diagnosis at 2·5 cm and repair at 5·0 cm) was estimated to have an incremental cost-effectiveness ratio of £23000 (9500-71000) per quality-adjusted life year and 1800 invitations to screening required to prevent one AAA-death, but an overdiagnosis rate of 55%. There was considerable uncertainty in the cost-effectiveness ratio, largely driven by uncertainty about AAA prevalence, the distribution of aortic sizes for women at different ages, and the effect of screening on quality of life. INTERPRETATION: B
AU - Sweeting,MJ
AU - Masconi,KL
AU - Jones,E
AU - Ulug,P
AU - Glover,MJ
AU - Michaels,JA
AU - Bown,MJ
AU - Powell,JT
AU - Thompson,SG
DO - 10.1016/S0140-6736(18)31222-4
EP - 495
PY - 2018///
SP - 487
TI - Analysis of clinical benefit, harms, and cost-effectiveness of screening women for abdominal aortic aneurysm.
T2 - Lancet
UR - http://dx.doi.org/10.1016/S0140-6736(18)31222-4
UR - https://www.ncbi.nlm.nih.gov/pubmed/30057105
UR - http://hdl.handle.net/10044/1/61628
VL - 392
ER -