Biologics Effective but Costly in Psoriatic Arthritis

Compared to conventionaltherapies, biologic therapies are more effective, but more costly, in treating psoriatic arthritis, according to a new study, one of the first to assess the real-world costs of biologics in this patient group. The drug costs for treating psoriasis and psoriatic arthritis in the U.S. have increased tremendously in the 2000s, with a major contribution from biologic therapies. This increase in drug spending has led to a heavier economic burden on healthcare systems. The authors of the study, led by Tsong-Shing Yang of Chang Gung University College of Medicine, Chiayi, Taiwan, evaluated the cost-effectiveness of etanercept, adalimumab and golimumab in treating active psoriatic arthritis in a Taiwanese setting. Anti-tumor necrosis factor alpha agents, such as these three, have established efficacy in treating psoriatic arthritis.  Published in the Sept. 25 online issue of the International Journal of Rheumatic Diseases, the researchers conducted a meta-analysis of randomized placebo-controlled trials to calculate the incremental efficacy of these three drugs in achieving Psoriatic Arthritis Response Criteria (PsARC) and a 20% improvement in the American College of Rheumatology score (ACR20). They calculated the base, best, and worst case incremental cost-effectiveness ratios for one subject to achieve PsARC and ACR20.

Their results show that the annual incremental cost-effectiveness ratios (in U.S. dollars) per PsARC responder were $27,047 (best scenario $16,619; worst scenario $31,350) for etanercept, $39,339 (best scenario $31,846; worst scenario $53,501) for adalimumab, and $27,085 (best scenario $22716; worst scenario $33534) for golimumab. The annual incremental cost-effectiveness ratios per ACR20 responder were $27,588 (best scenario $20,900; worst scenario $41,800) for etanercept, $39,339 (best scenario $25,236; worst scenario $83595) for adalimumab, and $33534 (best scenario $27,616; worst scenario $44,013) for golimumab. In conclusion, the researchers stated that “in a Taiwanese setting, etanercept had the lowest annual costs per PsARC and ACR20 responder, while adalimumab had the highest annual costs per PsARC and ACR responder.” Golimumab had modest costs per PsARC and ACR20 responder. The message to clinicians seems to be to consider both efficacy and cost-effectiveness, along with patient values and characteristics of psoriatic arthritis, in deciding how to efficiently allocate resources in treating psoriatic arthritis patients. 

References:

Yang TS, Chi CC, et al. "Cost-efficacy of biologic therapies for psoriatic arthritis from the perspective of the Taiwanese healthcare system,"International Journal of Rheumatic Diseases. Published online Sept. 25, 2015. DOI: 10.1111/1756-185X.12744