OBJECTIVES: : A cost-utility model was developed to assess the impact of placing apremilast, a new oral treatment, before biologics in patients with moderate to severe plaque psoriasis who have failed to respond to, have a contraindication to, or are intolerant to other systemic treatments from a Spain payer perspective. METHODS: A 20-year Markov model with monthly cycle duration was developed. Treatment strategies consisted of apremilast prior to a biologic drug sequence compared with a biologic-only sequence. Sequential biologics, based on Spanish clinical practice, were adalimumab, ustekinumab, etanercept, and infliximab for both strategies. Patients who failed infliximab were assumed to receive best supportive care. A ≥75% reduction in Psoriasis Area and Severity Index was used as the efficacy measure. Drug response rates were derived from a meta-analysis. All-cause overall mortality was considered. Resource consumption was estimated by an expert panel; biologic doses were taken from summaries of the product characteristics. According to the NHS perspective, total costs included drug acquisition (ex-factory price with mandatory deduction), administration (parenteral drugs), and monitoring costs. Unit costs (€, 2014) were obtained from national databases. An annual discount rate of 3% was applied for costs and health benefits. Utilities were estimated from PASI response using a published regression equation. Sensitivity analyses were performed to test model robustness. RESULTS: The administration of apremilast before a sequence of biologic drugs was estimated to provide an additional 0.12 quality-adjusted life-years (QALYs): 12.37 QALYs vs. 12.25 QALYs with the biologic-only sequence. In the base-case assumptions, the apremilast sequence yielded lower total costs vs. the biologic-only sequence (€216,490 vs. €224,359). CONCLUSIONS: The administration of apremilast before biologic drugs is a cost-saving strategy for the NHS in the treatment of patients with moderate to severe plaque psoriasis.  This analysis was limited in that the model did not consider cost-effectiveness issues.