OBJECTIVES:

Hydroxychloroquine (HCQ) can induce retinopathy, which may result in vision loss. Therefore, it is recommended that patients on long-term HCQ treatment are screened annually using Spectral Domain- Optical Coherence Tomography (SD-OCT) and Humphrey visual field analyzer (HFV). Although screening is effective, it is also costly and the risk for HCQ retinopathy differs between patients. Therefore, this study analyses the cost-effectiveness of screening for HCQ retinopathy.

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. 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 for patients receiving <4.0 mg/kg, 4-5 mg/kg, and >5 mg/kg HCQ. The current screening regimen was compared to no screening, screening after 5-15 years, and screening with solely an SD-OCT.

RESULTS:

Compared to no screening, the current screening regimen saved costs while gaining QALYs (€8,690 and 0.045 per patient in the general population). The use of solely an SD-OCT saved €443 per patient and lowered QALYs by 0.002. In a patient receiving <4.0 mg/kg it was more cost-effective to start screening after 15 years instead of after 5 years (saving €1,157 while lowering QALYs by 0.008). In a patient receiving >5mg/kg it was more cost-effective to start screening after 10 years instead of directly after treatment (saving €1000 while lowering QALYs by 0.002).

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.