Open Access Highly Accessed Research article

Systematic review, network meta-analysis and economic evaluation of biological therapy for the management of active psoriatic arthritis

Matthew Richard Cawson1, Stephen Andrew Mitchell2*, Chris Knight1, Henry Wildey1, Dean Spurden3, Alex Bird3 and Michelle Elaine Orme4

Author Affiliations

1 RTI Health Solutions, Sheffield, UK

2 Abacus International, 6 Talisman Business Centre, Talisman Road, Bicester OX26 6HR, UK

3 Pfizer Ltd, Surrey, UK

4 ICERA Consulting Ltd, Swindon, UK

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BMC Musculoskeletal Disorders 2014, 15:26  doi:10.1186/1471-2474-15-26

Published: 20 January 2014



An updated economic evaluation was conducted to compare the cost-effectiveness of the four tumour necrosis factor (TNF)-α inhibitors adalimumab, etanercept, golimumab and infliximab in active, progressive psoriatic arthritis (PsA) where response to standard treatment has been inadequate.


A systematic review was conducted to identify relevant, recently published studies and the new trial data were synthesised, via a Bayesian network meta-analysis (NMA), to estimate the relative efficacy of the TNF-α inhibitors in terms of Psoriatic Arthritis Response Criteria (PsARC) response, Health Assessment Questionnaire (HAQ) scores and Psoriasis Area and Severity Index (PASI). A previously developed economic model was updated with the new meta-analysis results and current cost data. The model was adapted to delineate patients by PASI 50%, 75% and 90% response rates to differentiate between psoriasis outcomes.


All four licensed TNF-α inhibitors were significantly more effective than placebo in achieving PsARC response in patients with active PsA. Adalimumab, etanercept and infliximab were significantly more effective than placebo in improving HAQ scores in patients who had achieved a PsARC response and in improving HAQ scores in PsARC non-responders. In an analysis using 1,000 model simulations, on average etanercept was the most cost-effective treatment and, at the National Institute for Health and Care Excellence willingness-to-pay threshold of between £20,000 to £30,000, etanercept is the preferred option.


The economic analysis agrees with the conclusions from the previous models, in that biologics are shown to be cost-effective for treating patients with active PsA compared with the conventional management strategy. In particular, etanercept is cost-effective compared with the other biologic treatments.