{
  "abstract": "Background\n\nDisease-modifying antirheumatic drugs (DMARDs) are standard first-line therapy for psoriatic arthritis (PsA). Observational studies suggest earlier initiation is associated with superior minimal disease activity (MDA) attainment, yet the economic and health implications of treatment timing remain uncertain. This cost-utility analysis evaluated the cost-effectiveness of early versus delayed DMARD initiation in DMARD-naive adults with PsA from a U.S. payer perspective.Methods\n\nWe built a cohort state-transition (Markov) model (monthly cycles, 15-year horizon) from published data (2000-2025). Patients initiated a DMARD under two strategies: early (≤1 year post-diagnosis) and delayed initiation (>1 year). Patients remained in the pre-treatment state for six months prior to response assignment, then transitioned among complete response (sustained MDA), partial response (non-sustained MDA), non-response, no treatment, and death. Primary outcomes included the incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (INMB). Uncertainty intervals (UIs) were derived from probabilistic sensitivity analyses.Findings\n\nEarly DMARD initiation provided an additional 0.56 (95% UI, 0.32-0.83) QALYs at an incremental cost of -US$43,902.94 (95% UI, -US$147,096.29 to US$61,615.86) per patient relative to delayed initiation, yielding a favourable ICER (-US$78,398.11/QALY). At a willingness-to-pay threshold of US$50,000/QALY, mean INMB was US$71,902.94 (95% UI, -US$36,663.51 to US$176,658.91), with early initiation preferred in 90.6% of simulations.Interpretation\n\nEarly DMARD initiation was associated with improved long-term health outcomes at reduced costs, suggesting timely DMARD initiation may represent a high-value strategy. Given the observational basis of the key treatment-timing input, findings support disease-duration stratified analyses of existing phase III trials and further characterization of access delays.Funding\n\nNone.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Medicine, University of Calgary, Calgary, Alberta, Canada.",
    "Division of Experimental Medicine, McGill University Health Centre, Montreal, Quebec, Canada.",
    "Department of Health Research Methods, McMaster University, Hamilton, Ontario, Canada.",
    "Department of Medicine, University of Montreal, Montreal, Quebec, Canada.",
    "Department of Rheumatology, University of Alberta, Edmonton, Alberta, Canada.",
    "Department of Mathematics and General Sciences, Prince Sultan University, Riyadh, Saudi Arabia.",
    "Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada.",
    "Department of Surgery, Mary Washington Healthcare, Fredericksburg, VA, USA.",
    "Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada.",
    "Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.",
    "Centre de Recherche Dermatologique du Québec (CRDQ), Quebec, Canada.",
    "Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada.",
    "Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.",
    "Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0,
        1
      ],
      "name": "Sabrina Hundal",
      "orcid": "0000-0002-8855-4491"
    },
    {
      "affs": [
        2
      ],
      "name": "Julian Cappelli"
    },
    {
      "affs": [
        3
      ],
      "name": "Savanah Haidar"
    },
    {
      "affs": [
        4
      ],
      "name": "Mohamed Osman"
    },
    {
      "affs": [
        5
      ],
      "name": "Mohammed Kaouache"
    },
    {
      "affs": [
        6
      ],
      "name": "Elham Rahme"
    },
    {
      "affs": [
        7
      ],
      "name": "Stephanie R Goldberg"
    },
    {
      "affs": [
        8,
        9
      ],
      "name": "Dafna D Gladman"
    },
    {
      "affs": [
        10,
        11
      ],
      "name": "Julien Ringuet"
    },
    {
      "affs": [
        12
      ],
      "name": "Anastasiya Muntyanu",
      "orcid": "0000-0002-9776-866X"
    },
    {
      "affs": [
        13
      ],
      "name": "Alexander Tsoukas"
    },
    {
      "affs": [
        11
      ],
      "name": "Elena Netchiporouk"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3d8bgaz9b0xt7.bib",
  "cited_by": 0,
  "doi": "10.1016/j.lana.2026.101661",
  "fulltext_url": "https://europepmc.org/articles/PMC13693057",
  "id": "3d8bgaz9b0xt7",
  "issns": [
    "2667-193X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42921371",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2745|Spondyloarthritis Studies and Treatments"
    ]
  ],
  "openalex": "W7221807040",
  "pdf_url": "https://europepmc.org/articles/PMC13693057?pdf=render",
  "pmcid": "PMC13693057",
  "pmid": "42921371",
  "published": "2026-10-14",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/3d8bgaz9b0xt7.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:33Z",
      "native_id": "MED:42921371",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42921371"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2745|Spondyloarthritis Studies and Treatments",
      "subfield": "general"
    }
  ],
  "title": "Cost-effectiveness of early versus delayed disease-modifying antirheumatic drugs for psoriatic arthritis.",
  "title_text": "Cost-effectiveness of early versus delayed disease-modifying antirheumatic drugs for psoriatic arthritis.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:33Z",
  "url": "https://research.draconitic.com/paper/3d8bgaz9b0xt7",
  "venue": "Lancet regional health. Americas",
  "versions": []
}