Cost-effectiveness of early versus delayed disease-modifying antirheumatic drugs for psoriatic arthritis.
14 affiliations
- 1Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
- 2Division of Experimental Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
- 3Department of Health Research Methods, McMaster University, Hamilton, Ontario, Canada.
- 4Department of Medicine, University of Montreal, Montreal, Quebec, Canada.
- 5Department of Rheumatology, University of Alberta, Edmonton, Alberta, Canada.
- 6Department of Mathematics and General Sciences, Prince Sultan University, Riyadh, Saudi Arabia.
- 7Division of Clinical Epidemiology, McGill University, Montreal, Quebec, Canada.
- 8Department of Surgery, Mary Washington Healthcare, Fredericksburg, VA, USA.
- 9Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada.
- 10Schroeder Arthritis Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
- 11Centre de Recherche Dermatologique du Québec (CRDQ), Quebec, Canada.
- 12Division of Dermatology, McGill University Health Centre, Montreal, Quebec, Canada.
- 13Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
- 14Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada.
Abstract
Background
Disease-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
We 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
Early 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
Early 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
None.
Related
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BibTeX
@article{hundal2026costeffectiveness,
title = {{Cost-effectiveness of early versus delayed disease-modifying antirheumatic drugs for psoriatic arthritis.}},
author = {Sabrina Hundal and Julian Cappelli and Savanah Haidar and Mohamed Osman and Mohammed Kaouache and Elham Rahme and Stephanie R Goldberg and Dafna D Gladman and Julien Ringuet and Anastasiya Muntyanu and Alexander Tsoukas and Elena Netchiporouk},
journal = {Lancet regional health. Americas},
year = {2026},
month = oct,
doi = {10.1016/j.lana.2026.101661},
url = {https://europepmc.org/article/MED/42921371},
note = {CC BY},
}
RIS
TY - JOUR
TI - Cost-effectiveness of early versus delayed disease-modifying antirheumatic drugs for psoriatic arthritis.
AU - Sabrina Hundal
AU - Julian Cappelli
AU - Savanah Haidar
AU - Mohamed Osman
AU - Mohammed Kaouache
AU - Elham Rahme
AU - Stephanie R Goldberg
AU - Dafna D Gladman
AU - Julien Ringuet
AU - Anastasiya Muntyanu
AU - Alexander Tsoukas
AU - Elena Netchiporouk
PY - 2026
DA - 2026/10/14
JO - Lancet regional health. Americas
DO - 10.1016/j.lana.2026.101661
UR - https://europepmc.org/article/MED/42921371
AB - Background Disease-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 We 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 Early 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 Early 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 None.
SN - 2667-193X
ER -