OBJECTIVES: To evaluate the cost-effectiveness of apremilast, an oral inhibitor of the enzyme phosphodiesterase-4, in the treatment of psoriatic arthritis (PsA) in the Slovak Republic and Slovenia.

METHODS: A flexible Markov state transition cohort model was adapted using locally-specific drug costs and treatment costs for each of the two jurisdictions (Slovak Republic and Slovenia). Health states within the PsA model were assessed on the basis of Psoriatic Arthritis Response Criteria and the Health Assessment Questionnaire. Apremilast was compared with best supportive care (BSC), following the design of clinical trials, and with the requirement that the cost-effectiveness of apremilast was appraised in a conservative manner. Efficacy of apremilast and BSC used in the model was derived from a network meta-analysis. To assess the validity of the assumptions and robustness of the model, sensitivity analyses were undertaken, looking at varied costs of BSC, effectiveness of apremilast following the HAQ scale, and discontinuation rate of apremilast due to adverse events or ineffectiveness.

RESULTS: In patients suffering from PsA treatment with apremilast, when compared with BSC, resulted in an incremental cost-effectiveness ratio (ICER) of €11,418 per quality adjusted life year (QALY) in the Slovak Republic and €13,563 per QALY in Slovenia. This was below the willingness-to-pay threshold set up by the authorities in both jurisdictions. The sensitivity analysis showed robustness of the findings in both jurisdictions.

CONCLUSIONS: Results of this study indicate that the use of apremilast for the treatment of patients suffering from PsA in both the Slovak Republic and Slovenia is cost-effective.