OBJECTIVES: To determine the cost-effectiveness of apremilast for the treatment of active psoriatic arthritis for adult patients who failed to respond to or are intolerant to  disease-modifying antirheumatic drugs in Italy. METHODS: A Markov state-transition cohort model was adapted to the Italian setting to compare costs and quality-adjusted life-years (QALYs) from 2 treatment sequences: apremilast, adalimumab, etanercept, infliximab, and best supportive care (BSC) versus adalimumab, etanercept, infliximab, and BSC. The analysis time horizon was 40 years using a 28-day cycle length. The perspective of the Italian National Health Service (NHS) was chosen. Treatment efficacy data (based on American College of Rheumatology [ACR] 20 criteria and Psoriasis Area and Severity Index [PASI] 50/75/90 response rates) were derived from a network meta-analysis including 13 clinical trials. Resource use and unit costs were derived from Italian standard sources. Frequency of screening and testing for each treatment was derived from real-world data. Utility weights associated with PASI states were derived from a published study. A 3% discount rate was applied to costs and benefits. Both deterministic and probabilistic sensitivity analyses (PSA) were performed. RESULTS: In the base case, the sequence including apremilast resulted in an incremental cost per QALY gained of €32,263. Specifically, there was an increase of €13,511 (€182,209 vs €168,699) with an incremental gain of QALYs of 0.42 (9.57 vs 9.15) over 40 years. Base-case results were robust regarding changes in cost and efficacy data. Results were more sensitive to changes in utility weights, discount rates, and time horizon. The PSA confirmed that the apremilast sequence was cost-effective in the majority of the simulations at a willingness to pay of €50,000 per QALY. CONCLUSIONS: This analysis suggests that the use of apremilast for the treatment of psoriatic arthritis may represent a cost-effective option for the Italian NHS.