Purpose: We conduct a distributional cost-effectiveness analysis (DCEA) using routinely collected data to estimate the population health and health inequality impacts of the National Abdominal Aortic Aneurysm Screening Programme (NAAASP) in England. Methods: An existing discrete event simulation model of AAA screening was adapted to examine differences between socioeconomic groups defined by Index of Multiple Deprivation, obtained from an analyses of secondary data sources. We examined the distributional cost-effectiveness of being invited versus not invited at age 65 to screen using a National Health Service perspective. Changes in inequality are valued using a measure of equally distributed equivalent health. Results: The net health benefits of population screening (317 quality-adjusted life years (QALYs) gained) were disproportionately accounted for by impacts on those living in more advantaged areas. The NAAASP improved health on average compared to no screening, but the health opportunity cost of the programme exceeded the QALY gains for people living in the most deprived areas, resulting in a negative net health impact for this group (106 QALYs lost) that was driven by differences in the need for screening. Consequently, the NAAASP increased health inequality at the population level. Given current estimates for inequality aversion in England, screening for AAA remains the optimal strategy. Conclusion: Examination of the distributional cost-effectiveness of the NAAASP in England using routinely collected data revealed a trade-off between total population health and health inequality. Study findings suggest that the NAAASP provides value for money despite health impacts being disseminated to those who are more advantaged.
CORE (COnnecting REpositories)
CORE (COnnecting REpositories)