OBJECTIVES: A cost-utility model was developed to assess the impact of placing apremilast, a new oral treatment, before biologics for patients with active psoriatic arthritis (PsA) who failed to respond to or are intolerant of conventional disease-modifying antirheumatic drugs (DMARDs) from a Spain payer perspective. METHODS: A 20-year Markov model was developed. Treatment strategies consisted of apremilast before a biologic drug sequence compared with a biologic-only sequence. Sequential biologics were adalimumab, infliximab, etanercept, and golimumab for both strategies. Patients who failed golimumab were assumed to receive best supportive care. The Psoriatic Arthritis Response Criteria was used as the efficacy measure. Drug response rates were obtained from a meta-analysis. All-cause overall mortality was adjusted with a hazard ratio associated with PsA. Resource consumption was estimated by an expert panel, and biologic doses were taken from the summaries of product characteristics. The National Health System (NHS) perspective was considered, including the following costs: drug acquisition (ex-factory price with mandatory deduction), administration (parenteral drugs), and monitoring costs. Unit costs (€, 2014) were obtained from national databases. An annual 3% discount rate was applied for costs and outcomes. Published evidence was used to link HAQ-DI and PASI changes to utilities to generate quality-adjusted life-years (QALYs). Sensitivity analyses were performed to test model robustness. RESULTS: The administration of apremilast before a sequence of biologic drugs showed higher effectiveness (9.19 QALYs) than the biologic-only sequence (9.12 QALYs). The strategy with apremilast implied lower total costs (€206,539) than the biologic-only sequence (€215,330). Under base-case assumptions, placing apremilast before biologic drugs is a dominant strategy and it remained a dominant option when the drug order in the biologic-only sequence was modified using sensitivity analyses. CONCLUSIONS: The administration of apremilast before biologic drugs is a cost-saving strategy for the NHS in the treatment of patients with active PsA.