Ocular immunology and inflammation · 2026
Evaluating the Cost-Effectiveness of Systemic Disease Screening in Acute Anterior Uveitis.
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Kam Joseph, Mitchel Jacob, Sims Joanne L, Niederer Rachael L
Аннотация
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.
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.