Cost‐Effectiveness of Tight Control of Inflammation in Early Psoriatic Arthritis: Economic Analysis of a Multicenter Randomized Controlled Trial

Objective: Treat‐to‐target approaches have proved to be effective in rheumatoid arthritis, but have not been studied in psoriatic arthritis (PsA). This study was undertaken to examine the cost‐effectiveness of tight control (TC) of inflammation in early PsA compared to standard care.

Methods: Cost‐effectiveness analyses were undertaken alongside a UK‐based, open‐label, multicenter, randomized controlled trial. Taking the perspective of the health care sector, effectiveness was measured using the 3‐level EuroQol 5‐domain, which allows for the calculation of quality‐adjusted life‐years (QALYs). Incremental cost‐effectiveness ratios (ICERs) are presented, which represent the additional cost per QALY gained over a 48‐week time horizon. Sensitivity analyses are presented assessing the impact of variations in the analytical approach and assumptions on the cost‐effectiveness estimates.

Results: The mean cost and QALYs were higher in the TC group: £4,198 versus £2,000 and 0.602 versus 0.561. These values yielded an ICER of £53,948 per QALY. Bootstrapped uncertainty analysis suggests that the TC has a 0.07 probability of being cost‐effective at a £20,000 threshold. Stratified analysis suggests that with certain costs being controlled, an ICER of £24,639 can be calculated for patients with a higher degree of disease severity.

Conclusion: A tight control strategy to treat PsA is an effective intervention in the treatment pathway; however, this study does not find tight control to be cost‐effective in most analyses. Lower drug prices, targeting polyarthritis patients, or reducing the frequency of rheumatology visits may improve value for money metrics in future studies.