Abstract
Purpose :
Hydroxychloroquine (HCQ) can induce retinopathy, which may result in vision loss. Therefore, the current Dutch guideline recommends annual follow-up of patients on long-term HCQ treatment starting after 5 years in low-risk patients and after 1 year in high-risk patients. Although screening is effective, it is also costly and constitutes a high burden on ophthalmology clinics to provide these screenings using up time and resources.
Methods :
We developed a Markov model to calculate the costs and quality-adjusted life-years (QALYs) associated with different screening regimens from a Dutch societal perspective, over a lifetime horizon. The model described patients treated with HCQ that were at risk for retinopathy using as baseline input the clinical data of 359 cases of the Radboud university medical center. If retinopathy progressed undetected for over three years, it was assumed that a patient developed vision loss. The cost-effectiveness of the screening guideline was determined for the general population and patients receiving <4.0 mg/kg, 4-5 mg/kg, or >5 mg/kg HCQ per day. The current screening regimen was compared to no screening, screening after 5-20 years, screening with solely an SD-OCT, and biannual screening.
Results :
The current screening guideline saves costs (i.e., -€5,561 per patient), while improving patients' quality of life (i.e., 0.45 QALY per patient) in the general population in the Netherlands over a lifetime horizon, resulting in a dominant ICER. However, in patients receiving <4 mg/kg HCQ per day, it was found more cost-effective to initiate screening after 20 years, use solely an SD-OCT and follow a biannual screening regimen (i.e., ICER: €23,344). In patients receiving 4-5 mg kg HCQ per day or >5 mg/kg per day, it was more cost-effective to initiate screening after 10 years, use solely an SD-OCT and follow an annual regimen (respectively an ICER of €83,408 and €38,612).
Conclusions :
Although screening for HCQ retinopathy is cost-effective, later initiating of screening based on the dosage of a patient and use of solely an SD-OCT will help to improve cost-effectiveness. We recommend a new regimen using solely SD-OCT, where screening is initiated after 20 years in low-risk individuals, and 10 years in high-risk individuals.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.