OBJECTIVES:  Apremilast is an orally administered, small-molecule phosphodiesterase 4 inhibitor that works intracellularly to regulate inflammatory mediators associated with the pathogenesis of psoriatic arthritis (PsA). Apremilast was approved by the European Medicines Agency in 2015 for the treatment, alone or in combination with disease-modifying antirheumatic drugs (DMARDs), of active PsA in adult patients who have had an inadequate response or who have been intolerant to a prior DMARD therapy. We assessed the budget impact of introducing apremilast in the current treatment portfolio for PsA from the UK payer perspective. METHODS:

A 5-year budget impact model was developed for the UK; the target population was based on the total population, annual population growth rate, and prevalence of PsA. The total PsA population was divided into 3 categories: untreated patients, patients receiving conventional DMARD therapy, and patients treated with biologics. The analyses included all relevant biologic therapies (adalimumab, etanercept, golimumab, infliximab, and ustekinumab). Biosimilars for etanercept and infliximab were also included in the model. Drug costs were quoted from the British National Formulary (BNF) and the Monthly Index of Medical Specialties (MIMS). Administration costs, physician visit, and laboratory test costs were informed by National Health Service (NHS) reference costs and literature values. RESULTS:

Over a 5-year period, the number of patients treated with apremilast was estimated to increase from 15 to 1,573. The addition of apremilast to the treatment regimen decreased the total budget by 1.1% (£819,067,731 vs. £828,163,620) relative to a treatment regimen without apremilast. In the final year, drug acquisition costs decreased by 3.34% (£111,988,544 vs. £115,860,612), and administration and monitoring costs decreased by 0.69% (£51,901,617 vs. £52,262,395), yielding a net cost savings of 2.52%. CONCLUSIONS:

Inclusion of apremilast in the PsA treatment regimen in the UK was cost-saving in all respects.