Editor's Choice - Systematic Review on the Cost Effectiveness of Abdominal Aortic Aneurysm Screening in Women.

Abstract

Current abdominal aortic aneurysm (AAA) screening programmes primarily target men aged ≥ 65 years. Despite a lower prevalence, women experience higher aneurysm rupture rates, suggesting potential benefit from targeted screening. This systematic review evaluated the cost effectiveness of AAA screening in all women or high risk subgroups. MEDLINE and Embase were searched for studies from 2000 to 2025 reporting on the cost effectiveness of AAA screening in women. Studies needed to include sex disaggregated outcomes, number needed to treat, costs, or health economic analyses. Data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with risk of bias assessed using the ROBINS-I V2 tool. Study PROSPERO ID: CRD420250614983). The initial search identified 181 records, of which nine studies were included: one prospective cohort study and eight simulation based economic models, with data primarily from European or North American populations. AAA prevalence in women varied from 0.004% (Canada) to 1.15% (UK women aged 75 years). Quality adjusted life year gains were modest from 0.00075 to 0.02. Incremental cost effectiveness ratios for screening all women exceeded typical willingness to pay thresholds in all but one study. Two studies suggested increased cost effectiveness from screening women smokers for AAA: one finding that screening women smokers yielded the most favourable incremental cost effectiveness ratio ($24 000 per quality adjusted life year) and another showing that combining polygenic risk scoring with smoking status further improved the cost effectiveness of targeted screening in women aged 65 - 70 years. ROBINS-I assessment indicated six studies at moderate and three at serious risk of bias, mainly from confounding and missing data. GRADE evaluation indicated low to moderate certainty of evidence overall, with moderate certainty supporting targeted screening in high risk subgroups. Routine population based AAA screening for all women is unlikely to be cost effective. Targeted screening of high risk subgroups, such as women smokers or those with high polygenic risk scoring, may be a more economically viable approach.