OBJECTIVES: Psoriatic arthritis (PsA) is a unique inflammatory arthritis affecting joints and connective tissue, also impacting skin. Multiple PsA treatments are available or pending launch, necessitating payers to adopt a robust framework to evaluate their cost-effectiveness. A novel biologic treatment, IL-17A inhibitor secukinumab, is approved in the European Union for treatment of active PsA in adult patients with inadequate response to previous disease-modifying anti-rheumatic therapy. Our objective was to propose an improved modeling approach, by assessing existing HTA submissions and overcoming shortcomings, to assist decision makers in the effective assessment of PsA treatments.
METHODS: A targeted literature review was conducted to identify submissions for PsA treatments to major HTA agencies. Models were evaluated based on multiple parameters including proximity to clinical practice, treatment sequencing, and adverse events. After identifying shortcomings, an improved modeling framework was proposed.
RESULTS: All identified submissions used a similar structure with a short-term response criterion (Psoriatic Arthritis Response Criteria and/or change in Psoriasis Area and Severity Index) to determine initial treatment continuation. In the long-term, models allowed withdrawal from treatment due to adverse events or loss of efficacy. Shortcomings addressed by the proposed model include subsequent treatment lines and adverse event impact on mortality. The proposed model allows assessing different population types based on previous biologic experience (regardless, naïve, experienced) and psoriasis severity (mild, moderate to-severe), as well as the option to model subsequent biologic or conventional treatment lines via an additional Markov state. Key limitation is the lack of data for some treatments. This has to be further addressed to enable full model potential.
CONCLUSIONS: Existing HTA submissions use a common Markov structure in evaluation of PsA treatments. Although these incorporate most aspects of disease progression, areas of improvement were identified. The proposed framework can assist decision makers in determining the cost-effectiveness of PsA treatments more effectively.
