Rheumatology Advance Access originally published online on August 24, 2008
Rheumatology 2008 47(11):1664-1670; doi:10.1093/rheumatology/ken320
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The psoriatic arthritis cost evaluation study: a cost-of-illness study on tumour necrosis factor inhibitors in psoriatic arthritis patients with inadequate response to conventional therapy
1Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera, 2CIRFF/Center of Pharmacoeconomics, Faculty of Pharmacy, University Federico II of Naples, Naples, 3Rheumatic Disease Unit, Arcispedale S. Maria Nuova, Reggio Emilia, 4Rheumatology Unit II, University of Cagliari, Monserrato, 5Rheumatology and Rehabilitation Research Unit, Fondazione Maugeri IRCCS, Telese Terme, 6Rheumatology Unit, Department of Medical and Therapeutical Clinic, University "La Sapienza", Rome, 7Rheumatic Disease Unit, 2nd Division of Medicine, Prato Hospital, Prato, 8Rheumatology Department, University of Florence, Florence, 9Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova, Padova, 10Rheumatology Research Unit, University Federico II of Naples, Naples and 11Fondazione Charta, Milan, Italy.
Correspondence to: I. Olivieri, Rheumatology Department, Ospedale San Carlo, Contrada Macchia Romana, 85100 Potenza, Italy. E-mail: ignazioolivieri{at}tiscalinet.it; i.olivieri{at}ospedalesancarlo.it
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Abstract |
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Objective. To evaluate costs, benefits and cost–effectiveness of anti-TNF agents in PsA patients with inadequate response to conventional treatment.
Methods. A total of 107 patients, from nine Italian rheumatology centres, with different forms of PsA were given anti-TNF treatment, mainly etanercept (87%). Information on resource use, health-related quality of life, disease activity, function and laboratory values were collected at baseline and through out the 12 months of therapy. Cost (expressed in euro 2007) and utility (measured by EuroQol) before and after anti-TNF therapy initiation were compared in order to estimate the incremental cost per quality-adjusted life year (QALY) gained, and cost–effectiveness acceptability curve was calculated.
Results. At the end of 12 months, there was a significant increase in direct cost due to an increase of drug cost caused by TNF inhibitors that was only partially offset by the decrease in indirect cost. In the last 6 months of therapy, the direct cost increased by 
5052, the cost for the National Health System (NHS) by 5044 and the social cost by 4638. However, a gain of 0.12 QALY resulted in a cost per QALY gained of 40 876 for the NHS and of 37 591 for the society. The acceptability curve showed that there would be a 97% likelihood that anti-TNF therapy would be considered cost-effective at willingness-to-pay threshold of 60 000 per QALY gained.
Conclusion. Cost–effectiveness ratios are within the commonly accepted willingness-to-pay threshold. These results need to be confirmed in larger samples of patients.
KEY WORDS: Psoriatic arthritis, Anti-tumour necrosis factor, Cost–effectiveness, Quality-adjusted life year
Submitted 11 December 2007;
revised version accepted 8 July 2008.
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