Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
In the treatment of psoriatic arthritis (PsA), switching between alternative biologic treatments is common. A cost-effectiveness model was developed to assess the impact of placing apremilast, a new oral treatment, before biologics in PsA patients who had failed conventional disease-modifying antirheumatic drug therapy, from a U.S. payer perspective.
Methods:
A lifetime Markov state transition cohort model was developed to compare 2 treatment sequences in the base-case: apremilast followed by adalimumab followed by etanercept vs. adalimumab followed by etanercept. Patients who failed etanercept were assumed to receive best supportive care (BSC) as the last line of treatment. Response to therapy was assessed using the Psoriatic Arthritis Response Criteria (PsARC) at the end of the clinical trial periods, ranging from 12 to 16 weeks depending on drug. Non-responders moved to the next line of therapy. A 16.5% annual dropout rate was assumed for each drug. Treatment efficacy inputs were obtained from a meta-analysis and trial results. Drug costs were sourced from 2013 Wholesale Acquisition Costs prices, and a 3% annual discount rate was applied to costs and quality-adjusted life-years (QALYs). Apremilast was assumed to be priced at a discount to biologics. Utilities were estimated from the Health Assessment Questionnaire and Psoriasis Area and Severity Index response using a previously published regression equation.
Results:
The apremilast arm provided an additional 2.53 years with a PsARC response and an additional 0.78 QALYs. Total time spent on the biologics was reduced by 0.34 years and time spent in BSC was reduced by 2.85 years. Under base-case assumptions, placing apremilast before biologics was found to be the dominant strategy (costs reduced by $28,794). Sensitivity analyses indicated that several parameters (e.g., cost of BSC and baseline utility) influence the incremental cost-effectiveness ratio. Similar results were obtained with different biologic drugs in the sequence.
Conclusion:
Placing apremilast before biologics is a cost-saving strategy in the treatment of PsA.
Disclosure:
T. Tencer,
Celgene Corporation,
3;
Z. Clancy,
Celgene Corporation,
3;
H. Cawston,
Celgene Corporation,
2,
OptumInsight,
3;
S. Cure,
Celgene Corporation,
2,
OptumInsight,
3;
F. Zhang,
Celgene Corporation,
3.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/economic-evaluation-of-sequencing-strategies-in-the-treatment-of-psoriatic-arthritis-in-the-united-states/