Abstract
Background
Psoriatic arthritis is a long-term inflammatory arthropathy occurring in a subgroup of patients with psoriasis. In addition to irreversible bone erosions, joint destruction, and skin manifestations, psoriatic arthritis is associated with numerous comorbid conditions. Over the last 5 years, new treatments emerged; the analysis and comparisons of their additional costs and the added benefits have become increasingly important to optimize the limited resources available.
Methods
A systematic literature review covering PubMed, EMBASE, and the Cochrane Library was performed from May 2012 to October 2017 focusing on the most recent evidence of costs, benefits, and burden of psoriatic arthritis and its treatments. All economic evaluations assessing the burden of patients with psoriatic arthritis and written in English were eligible for inclusion. We also performed an assessment of the quality of the studies.
Results
Of the 1652 references found in the literature search, nine cost-effectiveness analyses and 12 cost-of-illness studies were included in the current review. Patients with psoriatic arthritis incur substantially higher direct and indirect costs, as compared with patients with psoriasis without arthritis or patients with other inflammatory diseases. The cost of treatment with biologic therapies is the major predictor of the total cost. However, individuals with psoriatic arthritis are also affected by substantial productivity losses and indirect costs. Biologic therapies are generally cost effective vs. conventional therapies (e.g., synthetic drugs) for treating psoriatic arthritis.
Conclusions
Psoriatic arthritis is associated with a significant economic burden and biologic therapies contribute significantly to these costs. Biologic therapies are more effective than disease-modifying anti-rheumatic drugs for the symptoms and signs of psoriatic arthritis and for improving quality of life and inhibiting structural radiological damage. Therefore, biologic therapies are cost effective compared with conventional therapies: the increased direct cost associated with biologic drugs is offset by the significant improvement in the efficacy of treatments and in patient management of psoriatic arthritis.
Similar content being viewed by others
References
Ogdie A, Schwartzman S, Husni ME. Recognizing and managing comorbidities in psoriatic arthritis. Curr Opin Rheumatol. 2015;27(2):118–26.
Kerschbaumer A, Fenzl K, Erlacher L, Aletaha D. An overview of psoriatic arthritis: epidemiology, clinical features, pathophysiology and novel treatment targets. Wien Klin Wochenschr. 2016;128:791–5.
Haddad A, Zisman D. Comorbidities in patients with psoriatic arthritis. Rambam Maimonides Med J. 2017;8(1):e0004.
Zhu B, Edson-Heredia E, Gatz JL, Guo J, Shuler CL. Treatment patterns and health care costs for patients with psoriatic arthritis on biologic therapy: a retrospective cohort study. Clin Ther. 2013;35:1376–85.
Cortesi PA, Scalone L, D’Angiolella L, Belisari A, Fusco F, Olivieri I, Mantovani LG. Systematic literature review on economic implications and pharmacoeconomic issues of psoriatic arthritis. Clin Exp Rheumatol. 2012;30(4 Suppl. 33):S126–31.
World Health Organization. Global report on psoriasis. 2016. http://apps.who.int/iris/bitstream/10665/204417/1/9789241565189_eng.pdf. Accessed 3 Feb 2018.
Kawalec P, Malinowski KP, Pilc A. Disease activity, quality of life and indirect costs of psoriatic arthritis in Poland. Rheumatol Int. 2016;36:1223–30.
Gossec L, Smolen JS, Ramiro S, de Wit M, Cutolo M, Dougados M, Emery P, Landewé R, Oliver S, Aletaha D, Betteridge N, Braun J, Burmester G, Cañete JD, Damjanov N, FitzGerald O, Haglund E, Helliwell P, Kvien TK, Lories R, Luger T, Maccarone M, Marzo-Ortega H, McGonagle D, McInnes IB, Olivieri I, Pavelka K, Schett G, Sieper J, van den Bosch F, Veale DJ, Wollenhaupt J, Zink A, van der Heijde D. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis. 2016;75(3):499–510.
Coates LC, Kavanaugh A, Ritchlin CT, GRAPPA Treatment Guideline Committee. Systematic review of treatments for psoriatic arthritis: 2014 update for the GRAPPA. J Rheumatol. 2014;41(11):2273–6.
Ramiro S, Smolen JS, Landewé R, van der Heijde D, Dougados M, Emery P, de Wit M, Cutolo M, Oliver S, Gossec L. Pharmacological treatment of psoriatic arthritis: a systematic literature review for the 2015 update of the EULAR recommendations for the management of psoriatic arthritis. Ann Rheum Dis. 2016;75(3):490–8.
D’Angelo S, Tramontano G, Gilio M, Leccese P, Olivieri I. Review of the treatment of psoriatic arthritis with biological agents: choice of drug for initial therapy and switch therapy for non-responders. Open Access Rheumatol. 2017;9:21–8.
Olivieri I, D’Angelo S, Palazzi C, Padula A. Advances in the management of psoriatic arthritis. Nat Rev Rheumatol. 2014;10(9):531–42.
Drummond M, Sculpher M, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press; 1997.
Löfvendahl S, Jöud A, Petersson IF, Theander E, Svensson Å, Carlsson KS. Income disparities in healthcare use remain after controlling for healthcare need: evidence from Swedish register data on psoriasis and psoriatic arthritis. Eur J Health Econ. 2017. https://doi.org/10.1007/s10198-017-0895-5 (Epub ahead of print).
Greenberg JD, Palmer JB, Li Y, Herrera V, Tsang Y, Liao M. Healthcare resource use and direct costs in patients with ankylosing spondylitis and psoriatic arthritis in a large US cohort. J Rheumatol. 2016;43(1):88–96.
Kvamme MK, Lie E, Kvien TK, Kristiansen IS. Two-year direct and indirect costs for patients with inflammatory rheumatic joint diseases: data from real-life follow-up of patients in the NOR-DMARD registry. Rheumatology (Oxford). 2012;51:1618–27.
Palmer JB, Li Y, Herrera V, Liao M, Tran M, Ozturk ZE. Treatment patterns and costs for anti-TNFalpha biologic therapy in patients with psoriatic arthritis. BMC Musculoskelet Disord. 2016;17:261.
Schwartzman S, Li Y, Zhou H, Palmer JB. Economic impact of biologic utilization patterns in patients with psoriatic arthritis. Clin Rheumatol. 2017;36(7):1579–88.
Löfvendahl S, Petersson IF, Theander E, Svensson Å, Zhou C, Steen Carlsson K. Incremental costs for psoriasis and psoriatic arthritis in a population-based cohort in southern Sweden: is it all psoriasis-attributable morbidity? J Rheumatol. 2016;43(3):640–7.
Raciborski F, Śliwczyński A, Kłak A, Kwiatkowska B, Brzozowska M, Tłustochowicz M. Prevalence of psoriatic arthritis and costs generated by treatment of psoriatic arthritis patients in the public health system: the case of Poland. Reumatologia. 2016;54:278–84.
Kristensen LE, Jørgensen TS, Christensen R, Gudbergsen H, Dreyer L, Ballegaard C, et al. Societal costs and patients’ experience of health inequities before and after diagnosis of psoriatic arthritis: a Danish cohort study. Ann Rheum Dis. 2017;76(9):1495–501.
Al Sawah S, Foster SA, Goldblum OM, Malatestinic WN, Zhu B, Shi N, et al. Healthcare costs in psoriasis and psoriasis sub-groups over time following psoriasis diagnosis. J Med Econ. 2017;20(9):982–90.
Kruntorádová K, Klimeš J, Šedová L, Štolfa J, Doležal T, Petříková A. Work productivity and costs related to patients with ankylosing spondylitis, rheumatoid arthritis, and psoriasis. Value Health Reg Issues. 2014;4:100–6.
Kirson NY, Rao S, Birnbaum HG, Kantor E, Wei RS, Cifaldi M. Matching-adjusted indirect comparison of adalimumab vs etanercept and infliximab for the treatment of psoriatic arthritis. J Med Econ. 2013;16:479–89.
O’Dwyer JL, Meads DM, Hulme CT, McParland L, Brown S, Coates LC, Moverley AR, Emery P, Conaghan PG, Helliwell PS. Cost-effectiveness of tight control of inflammation in early psoriatic arthritis: economic analysis of a multicenter randomized controlled trial. Arthritis Care Res (Hoboken). 2017. https://doi.org/10.1002/acr.23293 (Epub ahead of print).
O’Connor J, Rice S, Smith A, Rodgers M, Lopez RR, Craig D, Woolacott N. The clinical and cost effectiveness of ustekinumab for the treatment of psoriatic arthritis: a critique of the evidence. Pharmacoeconomics. 2016;34:337–48.
Cummins E, Asseburg C, Prasad M, Buchanan J, Punekar YS. Cost effectiveness of golimumab for the treatment of active psoriatic arthritis. Eur J Health Econ. 2012;13:801–9.
Strand V, Husni E, Griffith J, Zhou Z-Y, Signorovitch J, Ganguli A. Economic evaluation of timely versus delayed use of tumor necrosis factor inhibitors for treatment of psoriatic arthritis in the US. Rheumatol Ther. 2016;3(2):305–22.
Yang TS, Chi CC, Wang SH, Lin JC, Lin KM. Cost-efficacy of biologic therapies for psoriatic arthritis from the perspective of the Taiwanese healthcare system. Int J Rheum Dis. 2016;19:1002–9.
Corbett M, Chehadah F, Biswas M, Moe-Byrne T, Palmer S, Soares M, Walton M, Harden M, Ho P, Woolacott N, Bojke L. Certolizumab pegol and secukinumab for treating active psoriatic arthritis following inadequate response to disease-modifying antirheumatic drugs: a systematic review and economic evaluation. Health Technol Assess. 2017;21(56):1–326.
Goeree R, Chiva-Razavi S, Gunda P, Graham CN, Miles L, Nikoglou E, Jugl SM, Gladman DD. Cost-effectiveness analysis of secukinumab for the treatment of active psoriatic arthritis: a Canadian perspective. J Med Econ. 2018;21(2):163–73.
Olivieri I, Cortesi PA, de Portu S, Salvarani C, Cauli A, Lubrano E, Spadaro A, Cantini F, Ciampichini R, Cutro MS, Mathieu A, Matucci-Cerinic M, Punzi L, Scarpa R, Mantovani LG, PACE Working Group. Long-term costs and outcomes in psoriatic arthritis patients not responding to conventional therapy treated with tumour necrosis factor inhibitors: the extension of the Psoriatic Arthritis Cost Evaluation (PACE) study. Clin Exp Rheumatol. 2016;34(1):68–75.
Author information
Authors and Affiliations
Contributions
LSD and PAC wrote the first draft of the manuscript. MM and SM conducted literature searches. AL oversaw data assembly and collection and provided summaries of previous research studies. GC and LGM reviewed and supervised the activities. All authors have materially participated in the research and the manuscript preparation.
Corresponding author
Ethics declarations
Funding
No sources of funding were received for the preparation of this article.
Conflict of interest
Lucia S. D’Angiolella, Paolo Angelo Cortesi, Alessandra Lafranconi, Mariangela Micale, Sveva Mangano, Giancarlo Cesana, and Lorenzo G. Mantovani have no conflicts of interest directly relevant to the content of this article.
Rights and permissions
About this article
Cite this article
D’Angiolella, L.S., Cortesi, P.A., Lafranconi, A. et al. Cost and Cost Effectiveness of Treatments for Psoriatic Arthritis: A Systematic Literature Review. PharmacoEconomics 36, 567–589 (2018). https://doi.org/10.1007/s40273-018-0618-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40273-018-0618-5