In this article Jason Noble, MD, and co-authors compare the costs of the initial evaluation of anterior uveitis according to current practice patterns to recommended guidelines published from the Canadian National Uveitis Survey (CNUS, 2007 version). The authors compare the costs of initial evaluations for four specific clinical scenarios: 1) nongranulomatous anterior uveitis in an adult, 2) granulomatous anterior uveitis in an adult, 3) granulomatous anterior uveitis with suspected sarcoidosis in an adult or a child, and 4) nongranulomatous anterior uveitis in a child.
Using these four clinical scenarios, the authors compare current practice patterns vs evidence-based guidelines using a cost-minimization model. The authors found that many ophthalmologists tended to order more tests than were recommended by the guidelines for each of the scenarios studied (P-value < 0.05) and that additional cost were incurred across all four clinical scenarios. They reported minimal additional costs of: $75 per patient was spent for the initial work-up investigating nongranulomatous anterior uveitis in an adult, $40 additional cost for the workup of granulomatous anterior uveitis in an adult, $36 additional cost for investigating an adult or child with suspected sarcoidosis, and $11 additional cost for a workup of a child with nongranulomatous anterior uveitis.
Sensitivity analyses revealed that the mathematical model that the authors used was robust. Using these estimates and projecting the incidence of anterior uveitis in Canada at 0.024 percent per year, the authors estimated an annual cost savings of $600,000 per year to the Canadian health care system if ophthalmologists used the recommended guidelines rather than their preferred clinical patterns.
This article is helpful to both the general ophthalmologist with an interest in uveitis as well as the uveitis specialist, with the following caveats. The authors present a cost-effectiveness analysis for the initial evaluation of anterior uveitis; therefore, these data may not be generalizable to the initial evaluations of other forms of uveitis or to follow-up evaluations for anterior uveitis should further investigation be required.
Further, it is possible that evidence-based guidelines for the initial evaluation of anterior uveitis may be different in the United States due to different prevalences of diseases associated with uveitis in the United States as a whole or in certain regions of the U.S. (i.e., anterior uveitis associated with Lyme disease).
Another potential limitation is that these cost effectiveness analyses are predicated on the assumption that the two diagnostic strategies (e.g. the evidence-based guidelines and the current practice patterns in Canada) are equivalent with respect to the clinical effectiveness of diagnosing or evaluating patients with anterior uveitis.
Cost effectiveness analyses are also influenced by variability of both cost and probability of the items studied; however, the sensitivity analysis demonstrates that in this case the authors' analyses appear to be highly robust. Nonetheless, it appears that the evidence-based guidelines are a more cost-effective means for the initial evaluation of the anterior uveitis in the four clinical scenarios described.
Dr. Thorne has no financial relationships to disclose.