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Abdominal Aortic Aneurysm Screening: How Many Life Years Lost from Underuse of the Medicare Screening Benefit?

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A Capsule Commentary to this article was published on 20 May 2014

ABSTRACT

BACKGROUND

Since 2007, Medicare has provided one-time abdominal aortic aneurysm (AAA) screening for men with smoking history, and men and women with a family history of AAA as part of its Welcome to Medicare visit.

OBJECTIVE

We examined utilization of the new AAA screening benefit and estimated how increased utilization could influence population health as measured by life years gained. Additionally, we explored the impact of expanding screening to women with smoking history.

DESIGN

Analysis of Medicare claims and a simulation model to estimate the effects of screening, using published data for parameter estimates.

SETTING

AAA screening in the primary care setting.

PATIENTS

Newly-enrolled Medicare beneficiaries aged 65 years, with smoking history or family history of AAA.

MAIN MEASURES

Life expectancy, 10-year survival rates.

KEY RESULTS

Medicare data revealed low utilization of AAA screening, under 1 % among those eligible. We estimate that screening could increase life expectancy per individual invited to screening for men with smoking history (0.11 years), with family history of AAA (0.17 years), and women with family history (0.08 years), and smoking history (0.09 years). Average gains of 131 life years per 1,000 persons screened for AAA compare favorably with the grade B United States Preventive Services Task Force (USPSTF) recommendation for breast cancer screening, which yields 95–128 life years per 1,000 women screened. These findings were robust over a range of scenarios.

LIMITATIONS

The simulation results reflect assumptions regarding AAA prevalence, treatment, and outcomes in specific populations based on published research and US survey data. Published data on women were limited.

CONCLUSIONS

The Welcome to Medicare and AAA screening benefits have been underutilized. Increasing utilization of AAA screening would yield substantial gains in life expectancy. Expanding screening to women with smoking history also has the potential for substantial health benefits.

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Acknowledgements

The authors wish to acknowledge the contributions of Dr. Robert Zwolak in reviewing the draft manuscript and in providing comments from a clinical and policy perspective.

Financial Support

This research was supported by Medtronic, Inc., Minneapolis, MN

Prior Presentations

The findings from this study were presented at the annual meeting of the International Society for Pharmacoeconomics and Outcomes Research in May 2013.

Conflict of Interest

The investigators retained full control of the study’s design, conduct, and reporting.

N. Olchanski: Project funding from Medtronic, Inc.

A. Winn: Project funding from Medtronic, Inc.

J. T. Cohen: Project funding from Medtronic, Inc.

P. J. Neumann: Project funding from Medtronic, Inc.

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Authors and Affiliations

  1. Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA

    N. Olchanski MS, A. Winn MPP, J. T. Cohen PhD & P. J. Neumann ScD

Authors
  1. N. Olchanski MS
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  2. A. Winn MPP
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  3. J. T. Cohen PhD
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  4. P. J. Neumann ScD
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Corresponding author

Correspondence to N. Olchanski MS.

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Olchanski, N., Winn, A., Cohen, J.T. et al. Abdominal Aortic Aneurysm Screening: How Many Life Years Lost from Underuse of the Medicare Screening Benefit?. J GEN INTERN MED 29, 1155–1161 (2014). https://doi.org/10.1007/s11606-014-2831-z

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  • DOI: https://doi.org/10.1007/s11606-014-2831-z

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