Journal Article

Modelling the impact of changes to abdominal aortic aneurysm screening and treatment services in England during the COVID-19 pandemic

Kim, Lois G., Nasim, Akhtar, Jacomelli, Jo, Armer, Morag, Sweeting, Michael J., Harrison, Seamus C.

2021

Overview

The National Health Service (NHS) abdominal aortic aneurysm (AAA) screening programme (NAAASP) in England screens 65-year-old men. The programme monitors those with an aneurysm, and early intervention for large aneurysms reduces ruptures and AAA-related mortality. AAA screening services have been disrupted following COVID-19 but it is not known how this may impact AAA-related mortality, or where efforts should be focussed as services resume. We repurposed a previously validated discrete event simulation model to investigate the impact of COVID-19-related service disruption on key outcomes. This model was used to explore the impact of delayed invitation and reduced attendance in men invited to screening. Additionally, we investigated the impact of temporarily suspending scans, increasing the threshold for elective surgery to 7cm and increasing drop-out in the AAA cohort under surveillance, using data from NAAASP to inform the population. Delaying invitation to primary screening up to two years had little impact on key outcomes whereas a 10% reduction in attendance could lead to a 2% lifetime increase in AAA-related deaths. In surveillance patients, a 1-year suspension of surveillance or increase in the elective threshold resulted in a 0.4% increase in excess AAA-related deaths (8% in those 5-5.4cm at the start). Longer suspensions or a doubling of drop-out from surveillance would have a pronounced impact on outcomes. Efforts should be directed towards encouraging men to attend AAA screening service appointments post-COVID-19. Those with AAAs on surveillance should be prioritised as the screening programme resumes, as changes to these services beyond one year are likely to have a larger impact on surgical burden and AAA-related mortality.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Abdomen / Abdominal aneurysm / Age / Age Factors / Aged / Aneurysms / Aorta / Aortic Aneurysm, Abdominal - complications / Aortic Aneurysm, Abdominal - diagnosis / Aortic Aneurysm, Abdominal - mortality / Aortic Aneurysm, Abdominal - surgery / Aortic aneurysms / Aortic Rupture - etiology / Aortic Rupture - mortality / Aortic Rupture - prevention & control / Care and treatment / Casualties / Clinical trials / Communicable Disease Control - standards / Computer Simulation / Control / Coronaviruses / Cost of Illness / COVID-19 / COVID-19 - epidemiology / COVID-19 - prevention & control / COVID-19 - transmission / Diagnosis / Discrete event systems / Disease transmission / Drafting software / Editing / Elective Surgical Procedures - standards / Elective Surgical Procedures - statistics & numerical data / England - epidemiology / Epidemics / Epidemiology / Health care / Health Policy / Health risks / Health surveillance / Humans / Investigations / Laboratories / Male / Mass Screening - organization & administration / Mass Screening - standards / Mass Screening - statistics & numerical data / Mathematical models / Medical care / Medicine and Health Sciences / Models, Statistical / Pandemics / Pandemics - prevention & control / Patient Acceptance of Health Care - statistics & numerical data / People and places / Population / Primary care / Public health / Reviews / Risk Assessment - statistics & numerical data / Risk Factors / Safety and security measures / Severity of Illness Index / Simulation / State Medicine - standards / State Medicine - statistics & numerical data / Surgery / Surveillance / Time-to-Treatment / Ultrasonic imaging / Ultrasonography - standards / Ultrasonography - statistics & numerical data / United Kingdom