title: AIMING FOR THE BULL'S EYE: The Cost-Utility of Screening for Hydroxychloroquine Retinopathy.
abstract: BACKGROUND
  Throughout medicine, the cost of various treatments has been increasingly studied with the result that certain management guidelines might be reevaluated in their context. Cost-utility is a term referring to the expense of preventing the loss of quality of life, quantified in dollars per quality-adjusted life year. In 2002, the American Academy of Ophthalmology published hydroxychloroquine screening recommendations which were revised in 2011. The purpose of this report is to estimate the cost-utility of these recommendations.
  
  
  METHODS
  A hypothetical care model of screening for hydroxychloroquine retinopathy was formulated. The costs of screening components were calculated using 2016 Medicare fee schedules from the Centers for Medicare and Medicaid Services.
  
  
  RESULTS
  The cost-utility of screening for hydroxychloroquine retinopathy with the 2011 American Academy of Ophthalmology guidelines was found to vary from 33,155 to 344,172 dollars per quality-adjusted life year depending on the type and number of objective screening tests chosen, practice setting, and the duration of hydroxychloroquine use. Screening had a more favorable cost-utility when the more sensitive and specific diagnostics were used, and for patients with an increased risk of toxicity.
  
  
  CONCLUSIONS
  American Academy of Ophthalmology guidelines have a wide-ranging cost-utility. Prudent clinical judgment of risk stratification and tests chosen is necessary to optimize cost-utility without compromising the efficacy of screening.
authors.affiliation: *Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; and †Department of Ophthalmology, Edward S. Harkness Eye Institute, College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: McClellan
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Chang
authors.forename: William E
authors.initials: WE
authors.lastname: Smiddy
mesh_terms: D000047:Academies and Institutes / Q000592:standards; D000962:Antimalarials / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D003362:Cost-Benefit Analysis; D003941:Diagnostic Techniques, Ophthalmological / Q000191:economics*; D004596:Electroretinography / Q000191:economics; D005260:Female; D005451:Fluorescein Angiography / Q000191:economics; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009885:Ophthalmology / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians'; D019057:Quality-Adjusted Life Years; D012164:Retinal Diseases / Q000139:chemically induced / Q000175:diagnosis* / Q000191:economics*; D012680:Sensitivity and Specificity; D041623:Tomography, Optical Coherence / Q000191:economics; D014481:United States
chemical_list: D000962:Antimalarials; D018501:Antirheumatic Agents; D006886:Hydroxychloroquine