Model to Determine the Cost-Effectiveness of Screening Psoriasis Patients for Psoriatic Arthritis

PROMPT Study Group, C. W. R. Tillett

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Abstract

Objective: Screening psoriasis patients for psoriatic arthritis (PsA) is intended to identify patients at earlier stages of the disease. Early treatment is expected to slow disease progression and delay the need for biologic therapy. Our objective was to determine the cost-effectiveness of screening for PsA in patients with psoriasis in Canada. Methods: A Markov model was built to estimate the costs and quality-adjusted life years (QALYs) of screening tools for PsA in psoriasis patients. The screening tools included the Toronto Psoriatic Arthritis Screen, Psoriasis Epidemiology Screening Tool, Psoriatic Arthritis Screening and Evaluation, and Early Psoriatic Arthritis Screening Questionnaire (EARP) questionnaires. States of health were defined by disability levels as measured by the Health Assessment Questionnaire. State transitions were modeled based on annual disease progression. Incremental cost-effectiveness ratios and incremental net monetary benefits were estimated. Sensitivity analyses were undertaken to account for parameter uncertainty and to test model assumptions. Results: Screening was cost-effective compared to no screening. The EARP tool had the lowest total cost ($2,000 per patient per year saved compared to no screening) and the highest total QALYs (additional 0.18 per patient compared to no screening). The results were most sensitive to test accuracy and the efficacy of disease-modifying antirheumatic drugs (DMARDs). No screening was cost-effective (at $50,000 per QALY) relative to screening when DMARDs failed to slow disease progression. Conclusion: If early therapy with DMARDs delays biologic treatment, implementing screening in patients with psoriasis in Canada is expected to represent a cost savings of $220 million per year and improve the quality of life.

Original languageEnglish
Pages (from-to)266-274
Number of pages9
JournalArthritis Care & Research
Volume73
Issue number2
Early online date15 Nov 2019
DOIs
Publication statusPublished - 1 Feb 2021

Bibliographical note

Funding Information:
The authors thank members of the Early Detection to Improve Outcome in People With Undiagnosed Psoriatic Arthritis study group who have been responsible for the acquisition of funding and general supervision of the research group: Anne Barton, Melanie Brooke, Sarah Brown, Laura Coates, Claire Davies, Emma Dures, Catherine Fernandez, Oliver Fitzgerald, Helen Harris, Philip Helliwell, Sarah Hewlett, Jana James, Anya Lissina, Vishnu Madhok, Neil McHugh, Alison Nightingale, Jonathan Packham, Andrew Parkinson, Gavin Shaddick, and William Tillett.

Publisher Copyright:
© 2019, American College of Rheumatology

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