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Costs of abdominal aortic aneurysm care at a regional Veterans Affairs medical center with the implementation of an abdominal aortic aneurysm screening program

Published:October 12, 2021DOI:https://doi.org/10.1016/j.jvs.2021.10.006

      Abstract

      Background

      Abdominal aortic aneurysm (AAA) screening has demonstrated to be cost-effective in reducing AAA-related morbidity and all-cause mortality. However, the downstream care costs of an implemented AAA screening in clinical practice have not been reported. The purpose of this study is to determine direct regional Department of Veterans Affairs (VA) costs in implementing and sustaining an AAA screening program over a 10-year period.

      Methods

      A cost data analysis (adjusted to 2021 U.S. dollars) of an AAA screening program was conducted from 2007 to 2016, where 19,649 veteran patients aged 65-75 with a smoking history were screened at a regional VA medical center. A decision support system tracked direct and indirect encounter costs from Medicare billing codes associated with AAA care. Costs from a patient’s initial screening, follow-up imaging, to AAA repair or at the end of the analysis period, March 31, 2021, were recorded. Costs for AAA repairs outside the VA system were also tracked.

      Results

      A total of 1,183 patients screened were identified with an AAA ≥3.0 cm without history of repair. Estimated screening costs were $2.8 million or $280,000 annually ($143/screening) in the care of 19,649 screened patients. There were 221 patients who required repair (143 repairs in VA, 78 repairs outside VA). The average cost of elective endovascular repair was $43,021 and that of open repair was $49,871. The total costs for all elective repairs were $9,692,591. Screening, implementation, maintenance, and surgical repair cost involved in the management of patients with AAA disease was $13.7 million, with $10,686 per life-year lived after repair (5.8 ± 3.5 mean life-years) and $490 per life-year lived after screening (6.9 ± 3.5 mean life-years) for all patients screened. There were 13 deaths of unknown causes and one patient with a ruptured AAA that required emergency repair at a cost of $124,392.

      CONCLUSIONS

      Despite known limitations, the implementation of an AAA ultrasound screening program is feasible, cost-effective, and a worthwhile endeavor.

      Keywords

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      References

        • Chaikof E.L.
        • Dalman R.L.
        • Eskandari M.K.
        • Jackson B.M.
        • Lee W.A.
        • Mansour M.A.
        • et al.
        The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm.
        J Vasc Surg. 2018; 67: 2-77.e2
        • Ashton H.A.
        • Buxton M.J.
        • Day N.E.
        • Kim L.G.
        • Marteau T.M.
        • Scott R.A.
        • et al.
        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
        • Ashton H.A.
        • Gao L.
        • Kim L.G.
        • Druce P.S.
        • Thompson S.G.
        • Scott R.A.
        Fifteen-year follow-up of a randomized clinical trial of ultrasonographic screening for abdominal aortic aneurysms.
        Br J Surg. 2007; 94: 696-701
        • Ying A.J.
        • Affan E.T.
        Abdominal aortic aneurysm screening: a systematic review and meta-analysis of efficacy and cost.
        Ann Vasc Surg. 2019; 54: 298-303.e3
        • Fleming C.
        • Whitlock E.P.
        • Beil T.L.
        • Lederle F.A.
        Screening for abdominal aortic aneurysm: a best-evidence systematic review for the U.S. Preventive Services Task Force.
        Ann Intern Med. 2005; 142: 203-211
        • LeFevre M.L.
        • United States Preventive Services Task Force
        Screening for abdominal aortic aneurysm: U.S. Preventive Services Task Force Recommendation Statement.
        Ann Intern Med. 2014; 161: 281-290
        • Owens D.K.
        • Davidson K.W.
        • Krist A.H.
        • Barry M.J.
        • Cabana M.
        • Caughey A.B.
        • et al.
        Screening for abdominal aortic aneurysm: US Preventive Services Task Force Recommendation Statement.
        JAMA. 2019; 322: 2211-2218
        • Brown D.W.
        Smoking prevalence among US veterans.
        J Gen Intern Med. 2010; 25: 147-149
        • Chun K.C.
        • Dolan K.J.
        • Smothers H.C.
        • Irwin Z.T.
        • Anderson R.C.
        • Gonzalves A.L.
        • et al.
        The 10-year outcomes of a regional abdominal aortic aneurysm screening program.
        J Vasc Surg. 2019; 70: 1123-1129
        • Bath M.F.
        • Sidloff D.
        • Saratzis A.
        • Bown M.J.
        • UK Aneurysm Growth Study investigators
        Impact of abdominal aortic aneurysm screening on quality of life.
        Br J Surg. 2018; 105: 203-208
        • O'Donnell T.F.X.
        • Landon B.E.
        • Schermerhorn M.L.
        The case for expanding abdominal aortic aneurysm screening.
        J Vasc Surg. 2020; 71: 1809-1812
        • Paraskevas K.I.
        • Brar R.
        • Constantinou J.
        • Tsui J.
        • Baker D.M.
        Screening programs for abdominal aortic aneurysms: luxury or necessity?.
        Angiology. 2019; 70: 385-387
        • Sprynger M.
        • Willems M.
        • Van Damme H.
        • Drieghe B.
        • Wautrecht J.C.
        • Moonen M.
        Screening program of abdominal aortic aneurysm.
        Angiology. 2019; 70: 407-413
        • Shreibati J.B.
        • Baker L.C.
        • Hlatky M.A.
        • Mell M.W.
        Impact of the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) act on abdominal ultrasonography use among Medicare beneficiaries.
        Arch Intern Med. 2012; 172: 1456-1462
        • Wanhainen A.
        • Hultgren R.
        • Linne A.
        • Holst J.
        • Gottsater A.
        • Langenskiold M.
        • et al.
        Outcome of the Swedish Nationwide Abdominal Aortic Aneurysm Screening Program.
        Circulation. 2016; 134: 1141-1148
        • Jacomelli J.
        • Summers L.
        • Stevenson A.
        • Lees T.
        • Earnshaw J.J.
        Impact of the first 5 years of a national abdominal aortic aneurysm screening programme.
        Br J Surg. 2016; 103: 1125-1131
        • Lee E.S.
        • Pickett E.
        • Hedayati N.
        • Dawson D.L.
        • Pevec W.C.
        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
        • Chun K.C.
        • Schmidt A.S.
        • Bains S.
        • Nguyen A.T.
        • Samadzadeh K.M.
        • Wilson M.D.
        • et al.
        Surveillance outcomes of small abdominal aortic aneurysms identified from a large screening program.
        J Vasc Surg. 2016; 63: 55-61
        • Barnett P.G.
        Review of methods to determine VA health care costs.
        Med Care. 1999; 37: AS9-AS17
        • Hendricks A.M.
        • Lotchin T.R.
        • Hutterer J.
        • Swanson J.
        • Kenneally K.
        • Decision Support System Cost Evaluation Work Group
        Evaluating VA patient-level expenditures: decision support system estimates and Medicare rates.
        Med Care. 2003; 41: II111-I117
        • Lederle F.A.
        • Stroupe K.T.
        • Kyriakides T.C.
        • Ge L.
        • Freischlag J.A.
        • Open vs Endovascular Repair Veterans Affairs Cooperative Study Group
        Long-term cost-effectiveness in the Veterans Affairs open vs endovascular repair study of aortic abdominal aneurysm: a randomized clinical trial.
        JAMA Surg. 2016; 151: 1139-1144
        • Schermerhorn M.
        Updated US Preventive Services Task Force recommendations for abdominal aortic aneurysm-are we really up to date?.
        JAMA Surg. 2020; 155: 101-103
        • Dinan M.A.
        • Curtis L.H.
        • Hammill B.G.
        • Patz Jr., E.F.
        • Abernethy A.P.
        • Shea A.M.
        • et al.
        Changes in the use and costs of diagnostic imaging among Medicare beneficiaries with cancer, 1999-2006.
        JAMA. 2010; 303: 1625-1631
        • Gross C.P.
        • Long J.B.
        • Ross J.S.
        • Abu-Khalaf M.M.
        • Wang R.
        • Killelea B.K.
        • et al.
        The cost of breast cancer screening in the Medicare population.
        JAMA Intern Med. 2013; 173: 220-226
        • Moses 3rd, H.
        • Matheson D.H.
        • Dorsey E.R.
        • George B.P.
        • Sadoff D.
        • Yoshimura S.
        The anatomy of health care in the United States.
        JAMA. 2013; 310: 1947-1963