Implementation of an aortic screening program in clinical practice: Implications for the Screen for Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act
Presented at the Twenty-third Annual Meeting of the Western Vascular Society, Napa, Calif, Sep 13-16, 2008.
Received 24 September 2008; accepted 3 December 2008. published online 23 March 2009.
Objective
Screening for abdominal aortic aneurysms (AAA) significantly reduces aneurysm-related death. In January 2007, the Federal government enacted Medicare coverage guideline to screen persons at risk for the presence of an AAA, the Screen for Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act. The purpose of this study is to evaluate the efficacy and costs of a large scale screening effort for identifying AAAs in patients in clinical practice.
Methods
A regional veterans affairs mandate for screening for AAA was implemented in February 2007. Data were extracted through the Northern California Veterans Affairs (VA) Service Network to identify veteran males 65-75 years of age who ever smoked at least 100 cigarettes during their lifetime. An AAA was defined as an aortic diameter 3.0 cm or greater. A Decision Support Systems software (LumiData, Minneapolis, Minn) package tracked true costs of conducting a large AAA screening protocol in the Northern California VA Health Care System.
Results
A total of 2918 patients (average age, 71 ± 6 years) were screened for AAA over a 1-year period from February 2007 to February 2008. An AAA was diagnosed in 5.1% (148/2918) of patients. Two hundred ninety patients out of the 2918 (9.9%) were inappropriately screened. The aneurysm distribution was as follows: 83% (123/148) of the aneurysms were 3.0-4.4 cm, 13% (19/148) were 4.5-5.5 cm, and 4.1% (6/148) were greater than 5.5 cm. Incidental findings of isolated iliac artery aneurysms were found in 0.1% (3/2918) of patients. The cost of AAA screening per patient is $53.
Conclusion
The results of a large AAA screening effort in clinical practice reflect the results reported in the major clinical trials at a reasonable cost. The identification of large iliac artery aneurysms in the screening has not been previously reported.
Department of Surgery, University of California, Davis and the Sacramento VA Medical Center, Sacramento, Calif
Reprint requests: Eugene S. Lee, MD, PhD, 4860 Y St, Suite 3400, Vascular Center, Sacramento, CA 95817
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