Abdominal Aortic Aneurysm Screening Survey Report for retrieving information on the use of technology in European countries This document describes the process of retrieving information on the Abdominal Aortic Aneurysm Screening technology made via a survey sent to European Countries through EUnetHTA Partner Agencies. This survey form an integral part of EUnetHTA Joint Action 1 Work Package 4 Core HTA. Important notice: This is a FINAL version of the Survey Report. It can be used as reference in the WP4 Core HTA 2 on AAA Screening by single domain for integration with the information included in each Domain text. Contents Introduction... 2 Description... 2 Survey... 3 Results... 7 Background of the project... 19 1
Introduction This report describes the Survey carried out as part of the EUnetHTA Joint Action 1 within Work Package 4 Strand B Core HTA 2 on Abdominal Aortic Aneurysm Screening. The survey was done for getting information on the use of AAA screening in European Countries; the information retrieved was used and integrated by each single Domain in the Core HTA. Description During the first phase of the Core HTA project on AAA Screening a literature search was made by the researchers working in the 9 domains that compose the Core HTA; following these basic literature review, a need for a further way for gathering information on the technology assessed emerged in different domains (mostly the Health Problem and Current Use and Cost and economic evaluation Domains). During the 2 nd face to face meeting of EUnetHTA Work Package 4 Strand B (Wien, September 29 30 2011) it was decided that each domain team would prepare some questions on their specific context. For technical aspects, support was asked to Work Package 3 Evaluation ; it was the decided to use an electronic survey through Survey Monkey, a web based tool for surveys that is free and easy to set up. Between October and November 2011, Agenas, as WP4 Strand B Lead Partner, gathered questions from each domain; furthermore it was decided that it would be better to have only one answer from each country so it was decided for each European country which EunetHTA Partner would receive the survey (for countries with more than one agency inside EUnetHTA). For each selected Agencies it was used the official contact person e mail address. On November 30 th, an official mail containing the link to the survey was sent out to 28 Partners, one for each Country; deadline for answers was set to after 3 weeks (December 21th 2011). After the deadline, as only 6 responses were collected a second communication was sent via e mail to the same contact person. On January 27 th 2012 the survey was closed and results gathered together; they were shared among the AAA Screening group on February 2 nd 2012; a total of 10 responses were collected from 10 different countries. Results of the survey was also presented during the Work Package 4 Strand B Workshop 3 (Wien, April 18 19 th 2012); to have a higher response rate, the AAA Screening Group decided to send out again the survey to European Partners. On April 24 th the survey communication was sent out again to official contact persons and to all Primary Investigators of AAA Screening Group; the deadline for responses was set to May 6th 2012. 2
A final total of 13 responses to the survey were gathered and shared within AAA Screening Group on May 10 th. Survey The following version is the.doc one of the Survey. The on line version was set up with Survey Monkey tool (www.surveymonkey.co); some minor changes in the structure of the survey were made to fit it with restrictions of the web tool used. Survey on abdominal aorta aneurysm (AAA) screening (2D-ultrasound or Doppler) [This questionnaire is addressed to experts in the context of an international collaboration on the assessment of the effect of AAA screening] NAME: AFFILIATION: PROFESSION: COUNTRY: 1. What is the burden (mortality, morbidity, disease specific mortality, life years lost, disability) of AAA in your country? 2. Does your health system have any preventive actions/programs regarding the risk of ruptured AAAs? Yes No Comment: If yes, indicate the type of screening strategy used (below): Population-based screening program (screening a defined healthy population (with defining a risk profile/an eligible population) by an invitation to a screening program) Please indicate target population / eligible population Gender: male female both Age: 60y 65y Risk factors: smoking AAA in the family If other eligibility criteria could you please specify which one(s)? Please describe, if possible How many people belong to the eligible population in your country? What is the attendance rate? What is the aim for the population based screening (if explicitly stated)? 3
How eligible population is identified (National registries, social insurance)? How participants are invited? By mail Other Please specify Is there is a quality assurance/evaluation component in the population based screening program. Opportunistic screening (individuals have sought medical advice for a specific symptom or complaint and opportunity is taken to suggest a screening) to be performed during a clinical consultation because of another health problem/condition Target population / eligible population Gender: male female both Age: 60y 65y Risk factors: smoking AAA in the family If other eligibility criteria could you please specify which one(s)? Please describe, if possible How many people belong to the eligible population in your country? What is the attendance rate? What is the aim for the opportunistic screening (if explicitly stated)? How eligible population is identified? How participants are invited? Any quality assurance/evaluation component in the population-based screening program? Other (secondary) preventive actions/programs/information campaigns Please describe, if possible Target population/eligible population (gender, age, disease, risk factors, etc.) for your action/program/information campaign How many people belong to the eligible population in your country and how many of them do actually enter the action/program/information campaign Is there an explicitly stated aim for the action/program/information campaign, How are participants identified and invited for the action/program/information campaign If there is a quality assurance/evaluation component in the action/program/information campaign 3. In which setting is AAA screening usually performed? In-patient Out-patient Please add details or additional information 4. Is there generally any guideline for AAA screening used in your country? Yes No 4
If yes, please name and refer to it (and if possible attach it) 5. Is there any guideline for patient information on AAA screening? Yes No If yes, please describe the issues included in the guideline for patient information (e.g. pros and cons, risk(s) involved, procedure, who to contact etc.) 6. Is there any guideline for patient information on the follow-up after AAA screening (e.g. information for patients detected with an aneurism needing regular follow-up)? Yes No If yes, please describe the issues included in the guideline for patient information on follow-up (e.g. procedure, common worries, who to contact etc.) 7. Has any technical device (and procedure) for the detection of AAA been established as gold standard in your country? Yes No If yes, please describe the gold standard (screening- or diagnostic test) and what diagnostic techniques are required to confirm the need of a surgical (preventive) intervention on AAA 8. Are there other technical devices besides the gold standard used for AAA screening? Yes No If yes, please describe the other technical devices (screening test or diagnostic test) 9. Who is responsible for the screening program? General practitioners Medical specialists Nurses are responsible for are responsible for are responsible for Medical/technical assistants are responsible for Other professionals are responsible for If possible provide information on which professionals use the technology, on who informs the participants, on who performs the screening test, on who performs the diagnostic test, on who performs the intervention etc. 10. What kind of interventions/surgery techniques are used to treat high risk AAAs? If possible name trials on the efficacy and safety of the intervention/surgery techniques you use. 11. How satisfied are patients and their relatives with the process of AAA screening? 5
12. How satisfied are doctors and health care organizations with the program of AAA screening? 13. Are there any problems related with the program of AAA screening? Yes No If yes, please describe the problems. If possible provide also information on how these problems could be solved. 14. How does reimbursement/funding work in your screening program? 15. What are the unit costs for following procedures (relevant for AAA screening) in your country? Cost Cost item ( ) Please specify, if another currency is used. Invitation to screening Ultrasound examination for AAA screening Ultrasound examination for follow-up Computer tomography for follow-up after AAA surgery Elective open surgery for AAA Elective endovascular surgery for AAA Emergency surgery for ruptured AAA Comment: Are the following items included in the cost? If yes, please tick the box. Preoperative care Postoperative care Follow -up Overhe ad costs/ fixed costs Other? Please specify in the field below. Which method was used in the estimation of costs? Please tick the correct box. Charge / Tariff Recomm ended price Casemix (e.g.d RG) Microcosting Other. Please specify in the field below. 6
Results The following slides contain the results from 13 responses gathered with the web tool. 7
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Background of the project In 2005 the first project of establishing a sustainable European Network on Health Technology Assessment (HTA) was set up with funds from the European Commission and the Council of Ministers; the first project included a group of 35 organizations in 27 European countries with the coordination of the Danish Centre for Evaluation and HTA. The main strategic objective of the network was to actively connect different HTA agencies and institutions, at national and/or regional level, in order to enable an effective exchange of information and to support policy makers decisions. The first step was to set up an organizational framework for a European Network on HTA and the development of practical tools and services. After the successful completion of the EunetHTA Project (2006 2008) the EUnetHTA Collaboration further developed the pillars for a sustainable and permanent collaboration for HTA in Europe. In 2009 25 Founding Partners of EUnetHTA Collaboration joined forces with other partners and the European Commission to implement results of the previous projects through a Joint Action on HTA 2010 2012: a total of 55 organisation committed their resources to participate in the planned activities within the framework of the EunetHTA Joint Action. The overarching objective of the EUnetHTA Joint Action 2010 2012 (JA) is to put into practice an effective and sustainable HTA collaboration in Europe that brings added value at the European, national and regional level. In October 2012 a second Joint Action will start and it will led to the creation of a permanent and sustainaible European Network for HTA throught the development of a general strategy, principals and an implementation proposal, according to the requirements of Article 15 of the Directive for cross border healthcare. 19