Cost-effectiveness of hydroxychloroquine retinopathy screening: the current guideline versus no screening and reduced regimens

OBJECTIVE: Hydroxychloroquine (HCQ) effectively treats autoimmune diseases but prolonged use may lead to retinopathy and subsequent vision loss. Guidelines suggest annual follow-up after 5 years for low-risk and 1 year for high-risk patients. This study evaluates the cost-effectiveness of current screening guidelines and a reduced regimen in the Netherlands from a societal perspective.

METHODS: A Markov model assessed costs and quality-adjusted life-years (QALYs) for current and reduced screening regimens. The model included 359 HCQ-treated patients from Radboud University Medical Center. Cost-effectiveness was examined in the general population and patients using < 5.0 mg/kg, 5.0-6.0 mg/kg, or > 6.0 mg/kg HCQ per day for several reduced regimens.

RESULTS: Compared to no screening, the current screening guideline saves costs (i.e., €210 per patient), while gaining QALYs (i.e., 0.79 QALY per patient) over a lifetime in the Netherlands. However, in patients receiving < 5.0 mg/kg HCQ per day, a biennial screening regimen after 10 years using SD-OCT was more cost-effective. For those with 5.0-6.0 mg/kg and > 6.0 mg/kg per day, initiating annual screening with an SD-OCT after 5 years was more cost-effective than the current guideline.

CONCLUSIONS: Screening for HCQ retinopathy is cost-effective, but delayed initiation and a reduced frequency, using solely an SD-OCT, are more cost-effective. We recommend screening with an SD-OCT and a biennial regimen after 10 years for low-risk patients, an annual regimen after 5 years for intermediate- and high-risk patients.