Tuesday, October 20, 2009: 4:30 PM
Grand Ballroom, Salon 5 (Renaissance Hollywood Hotel)
Sandra Spronk, PhD1, Bob JH van Kempen, BSc1, Torbjørn Wisløff, M.Sc.2, Johanna L. Bosch, PhD3, Myriam G.M. Hunink, PhD, MD1 and Ivar Sønbø Kristiansen, MD, PhD, MPH4, (1)Erasmus MC, Rotterdam, Netherlands, (2)Norwegian Knowledge Centre for the Health Services, Oslo, Norway, (3)Erasmus Medical Center, Rotterdam, Netherlands, (4)Institute of Health Economics, N-0317 Oslo, Denmark Norway
Purpose: This value of information (VOI) analysis was conducted to inform decision makers whether additional research on one-time screening for abdominal aortic aneurysms (AAA) in 65-year-old men would be worthwhile and which key parameters would be most valuable in an experimental design.
Method: We performed a second-order Monte Carlo simulation, in which costs and health outcomes of a one-time screening program and current practice were simulated over a lifetime European societal perspective. Data on clinical effectiveness and costs were derived from a primary database and the literature. VOI analysis was used to estimate the expected benefit of future research to eliminate the decision uncertainty that remained after completion of the analyses. We estimated the total expected value of perfect information (EVPI) and the expected value of perfect partial information (EVPPI) to identify the key parameters of future studies. It was estimated that in Europe about 116000 65-year old men with an AAA could be screened annually and would therefore benefit from future research in this area. The expected benefit of future research was expressed in Euros per patient and Euros for the European population, assuming a 5-year effective lifetime of the screening program and a 3% discount rate.
Result: As long as decision makers place a higher value than €18452 on a QALY, it is cost-effective to adopt a one time screening for AAAs in 65-year-old men. Using a societal WTP threshold of €20000 per QALY, the EVPI was €247 per patient and the value of perfect information for each yearly cohort of 65-year-old men of the European population was estimated to be €132 Million. Using a WTP threshold of €50000 per QALY, the EVPI per patient was €162 and the population EVPI approximately €87 Million, indicating that more research is justified. The EVPPI indicated that the most relevant information in future research could be obtained from research that evaluates the total in-hospital costs after emergency versus elective repair and the probability of rupture of an AAA.
Conclusion: Acquiring additional information on one-time screening for AAAs in 65-year-old men is cost-effective. The focus should be on the total in-hospital costs after emergency versus elective repair and the probability of rupture of the AAA.
Candidate for the Lee B. Lusted Student Prize Competition
