Abstract 248: Impact of the Screening for Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act on Abdominal Ultrasound Use Among Medicare Beneficiaries
Authors: Baras Shreibati Jacqueline , Baker Laurence C , Hlatky Mark A , Mell Matthew W 
Published: March 2022

Context:
Since January 1, 2007, Medicare has covered the costs of abdominal aortic aneurysm (AAA) screening for new male enrollees with a history of smoking under the Screening Abdominal Aortic Aneurysms Very Efficiently (SAAAVE) Act. The association of the Act with changes in rates of screening for AAA has not been well established.

Objective
: To determine whether the implementation of the SAAAVE Act was associated with changes in use of abdominal ultrasound for AAA screening among 65-year-old men (eligible) compared with a control group of 70-year-old men (not eligible).

Design, Setting, and Patients
: Retrospective, observational study of 65-year-old and 70-year-old men from a 20% random sample of Medicare fee-for-service beneficiaries from January 1, 2004, to December 31, 2009 (N%781,264). Data from the 2004 to 2008 Behavioral Risk Factor Surveillance System were used to estimate the prevalence of prior smoking among men 65 to 75 years of age. Logistic regression was used to examine the change in abdominal ultrasound use for 65-year-old versus 70-year-old men before (2004-2006) and after (2007-2009) SAAAVE Act implementation, adjusting for patient comorbidities, state-level smoking prevalence, geographic variation, and time trends.

Main Outcome Measures
: Abdominal ultrasound use, elective repair of AAA, hospitalization for AAA rupture, and all-cause mortality over 365 days of follow-up.

Results
: The prevalence of prior smoking among 65-to-75-year-old men during the study period was 65.6%. Prior to SAAAVE, in 2004, 7.6% (6965/91,836) of 65-year-old beneficiaries and 8.9% (8975/100,987) of 70-year-old beneficiaries received abdominal ultrasound. Following SAAAVE, in 2008, both age groups had similar rates of use at 9.6% (age 65: 9235/95,980; age 70: 9328/97,336). After multivariate adjustment, the relative increase in abdominal ultrasound use among 65-year-old Medicare beneficiaries after the SAAAVE Act was statistically significant (adjusted odds ratio [AOR] 1.15, 95% confidence interval [CI] 1.11-1.19, p < 0.001). The association of the SAAAVE Act with increases in abdominal ultrasound use differed by region (Northwest, AOR 1.10, 95% CI 1.02-1.19, p < 0.011; Midwest, AOR 1.23, 95% CI 1.15-1.33, p < 0.001; South, AOR 1.12, 95% CI 1.05-1.18; p < 0.001; West, AOR 1.18, 95% CI 1.09-1.28; p < 0.001). There was no statistically significant association of the SAAAVE Act with 365-day rates of AAA repair (AOR 0.76, 95% CI 0.55-1.05, p=0.10), hospitalization for ruptured AAA (AOR 0.87, 95% CI 0.28-2.68, p=0.81), or all-cause mortality (AOR 0.98, 95% CI 0.91-1.05, p=0.61).

Conclusion
: The SAAAVE Act was associated with a modest, yet significant, increase in abdominal ultrasound use during the first three years of implementation. The proportion of male Medicare enrollees that received AAA screening was a small fraction of the men eligible to be screened, suggesting substantial underuse of a service with proven clinical benefit.