Evaluating the Cost-Effectiveness of Systemic Disease Screening in Acute Anterior Uveitis

Purpose To evaluate the diagnostic yield, clinical utility and cost of common screening investigations in patients presenting with acute anterior uveitis (AAU).Methods Subjects with acute anterior uveitis were retrospectively identified from the Inflammatory Eye Disease Registry at Greenlane Clinical Centre, Auckland, New Zealand. Subjects were excluded if there was a pre-existing systemic disease known to cause AAU. Demographics, clinical presentation, diagnosis, human leukocyte antigen (HLA) B27, syphilis serology, serum angiotensin converting enzyme (ACE), chest x-ray and C-reactive protein (CRP) were assessed.Results 1040 subjects were included in the study. 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 CRP (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). Cost of screening per true positive identified was $178.37 for HLA-B27, $2,144.81 for syphilis serology, $4,470.93 for serum ACE, and $5,389.17 for chest x-ray.Conclusions The cost of screening in patients with AAU varied significantly between tests, with a high yield observed from HLA-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 AAU screening protocol must consider the diagnostic utility of an individual test and the cost of a missed systemic diagnosis.