OBJECTIVES: To determine the cost-efectiveness of etanercept compare to adalimumab, golimumab intravenous and subcutaneous, infliximab and ustekinumab for patients with psoriatic arthritis (PsA) in Colombia, who have not been treated with biological.

METHODS: A model was developed from the healthcare system perspective, structured as 12 weeks decision tree, used Psoriatic Arthritis Response Criteria (PsARC) to determine response to treatment, leading into a 10 years Markov model taking into account the disease progression. Those patients that did not respond in the 12 weeks are switched to a different therapy. It was performed using quality-adjusted life-years (QALYs), based on a link of Psoriasis Area Severity Index (PASI) and Health Assessment Questionnaire (HAQ), as a measure of effectiveness. Medical costs were calculated by multiplying the items of resource use by the associated unit costs according with the HAQ score. Effectiveness data were taken from the literature and indirect comparisons were made using a Bayesian method. The treatment costs considered only the initial management with the health technologies to compare. A discount rate of 5% was applied for both costs and outcomes. A sensitivity analysis on key variables of the model was performed.

RESULTS: Under assumptions, for patients with PsA the incremental cost-effectiveness ratio (ICER) etanercept compared to infliximab was about USD$ 15,802 per QALY, and the ICER of etanercept versus golimumab intravenous was about USD$ 296,265 per QALY. Adalimumab, ustekinumab and golimumab subcutaneous were dominated strategies. The probability of being cost-effective was 35% for etanercept, 33% for infliximab, 15% for adalimumab and 13% for golimumab IV, in a threshold of USD$ 18,819.

CONCLUSIONS: The results of this analysis suggest that etanercept appears to be a cost-effective option for the treatment of adult patients with PsA who are unresponsive to previous treatment, dominating ustekinumab, golimumab IV and adalimumab.