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

Sara W. Quist (), Sophie te Dorsthorst, Roel D. Freriks, Maarten J. Postma, Carel B. Hoyng and Freekje Asten
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Sara W. Quist: University of Groningen, University Medical Center
Sophie te Dorsthorst: Radboud University Medical Center
Roel D. Freriks: Asc Academics B.V.
Maarten J. Postma: University of Groningen, University Medical Center
Carel B. Hoyng: Radboud University Medical Center
Freekje Asten: Radboud University Medical Center

The European Journal of Health Economics, 2025, vol. 26, issue 3, No 6, 413-425

Abstract: Abstract 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 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 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.

Keywords: Cost-effectiveness; Hydroxychloroquine retinopathy; Screening guidelines (search for similar items in EconPapers)
Date: 2025
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DOI: 10.1007/s10198-024-01715-w

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