Routine screening for abdominal aortic aneurysms (AAAs) will be a reality in the US from the start of 2007. The Screening AAAs Very Effectively (SAAAVE) Act has been passed by Congress, and will take the form of an ultrasound scan as part of the one-time ‘Welcome to Medicare’ physical exam that is available to all 65 year olds who join Medicare each year.
The SAAAVE Act was conceived by the Society for Vascular Surgery (SVS) in early 2004. Dr Robert M Zwolak, Department of Vascular Surgery, Dartmouth-Hitchcock Medical Center (New Hampshire), is the chairman of the Government Relations Committee of the SVS. He told Vascular News: In November we got the provisions passed in the House and the Senate; although it is an idiosyncrasy of the system that our provisions are part of two larger Bills: the Budget Reconciliation Bill in the Senate and the Deficit Reduction Bill in the House.”
Zwolak explained that their cause was aided by the Preventative Services Task Force, which provided a “semi-independent endorsement of the screening program”. In fact, the Task Force’s recommendations were more stringent than the original ones from the SVS: the Task Force proposed that all men aged 65-75 years who have ever smoked should be screened. The SAAVE Act includes men who smoke and those with a history of aneurysms.
However, 2006 is a year of budget constraint, and there are some compromises in the Act. Only new entrants to Medicare part B will be screened – seniors who have already had their ‘Welcome to Medicare’ physical exam will not be retrospectively screened. By restricting the screening to only new Medicare entrants, the congressional budget estimate is only $200 million over five years. “This includes the cost of scan – at $50-70 a time – and aneurysm treatment,” he explained. There are many variables to the cost. There are 600,000 new Medicare beneficiaries every year; slightly less than half are male, but most have smoked at some point in their life, which leaves slightly less than 300,000 eligible candidates. The data on incidence and mortality from aneurysms are sketchy: “15,000 people die each year from ruptured AAAs”, Zwolak estimated. Around 60% of patients die before reaching the hospital, and another 20% die in the hospital after emergency surgery. “The major cost savings are for those who make it to the hospital as they use a huge amount of resources in terms of emergency surgery and recovery in intensive care. Elective AAA surgery with endovascular aortic repair takes 1-2 days in hospital, or 5-8 days for open surgery. For emergency cases they can be in hospital for months.”
The trouble is that AAAs are a secret disease. There isn’t much of a survivors’ group!” said Zwolak. With this in mind, SVS wants to increase the uptake of screening benefits such as this, which is currently only at around 10-15% of those eligible. “The next steps are for us to work with the Medicare authorities to provide a smooth implementation of the program, and to disseminate information on the danger of AAAs,” he concluded.