Evaluating the Cost-Effectiveness of Systemic Disease Screening in Acute Anterior Uveitis.
Human leukocyte antigen-B27 screening had lowest cost per true positive in acute anterior uveitis workup.
Evaluating the Cost-Effectiveness of Systemic Disease Screening in Acute Anterior Uveitis.
To evaluate the diagnostic yield, clinical utility and cost of common screening investigations in patients presenting with acute anterior uveitis (acute anterior uveitis).
Subjects with acute anterior uveitis were retrospectively identified from the Inflammatory Eye Disease Registry at Greenlane Clinical Centre, Auckland, New Zealand.
Median age was 43.9 years with 57.1% male.
Systemic disease was documented in 487 subjects (46.8%).
Predictors of systemic disease on multivariate analysis included younger age (OR 0.987 p = 0.006), hypopyon (OR 4.960 p = 0.015) and high c-reactive protein (OR 1.525 p = 0.009).
High intraocular pressure at presentation (≥24 mmHg) was associated with a lower risk of systemic disease (OR 0.229 p < 0.001) as was bilateral presentation (OR 0.417 p < 0.001).
The cost of screening in patients with acute anterior uveitis varied significantly between tests, with a high yield observed from human leukocyte antigen-B27 and syphilis and a low yield from sarcoid and chest x-ray.
Costs can be optimized by selecting higher-risk patients via history and examination. Any acute anterior uveitis screening protocol must consider the diagnostic utility of an individual test and the cost of a missed systemic diagnosis.