If early therapy with DMARDs can slow disease progression and delay expensive biologic treatment, early screening for psoriatic arthritis among patients with psoriasis could save $220 million each year in Canada and improve quality of life, according to data published in Arthritis Care & Research.
“The cost and health burden of PsA is considerable,” Nicolas Iragorri, MSc, of the University of Calgary, and colleagues wrote. “The average annual total cost of treatment per patient was estimated around U.S. $15,000 in Europe. Furthermore, late stages of PsA are associated with worse health outcomes and higher treatment costs mainly due to biologic therapy. The introduction of biologics is expected to result in a 3- to 5-fold increase in direct costs.”
“Currently, Canada lacks an organized screening program for PsA,” they added. “However, recent efforts have been directed towards understanding the effect of PsA screening. A meta-analysis compared the accuracy of the most widely used PsA screening tools. Additionally, the National Institute for Health Research (NIHR) is conducting a trial to evaluate the effect of screening for PsA on health outcomes. However, there is a knowledge gap regarding the health economic impact of implementing an organized screening program.”
To examine the cost-effectiveness of screening for PsA in Canadian patients with psoriasis, Iragorri and colleagues built a Markov model of a hypothetical cohort of patients aged 45 years with psoriasis, but not PsA, undergoing dermatological surveillance.
If early therapy with DMARDs can slow disease progression and delay expensive biologic treatment, early screening for PsA among patients with psoriasis could save $220 million each year in Canada and improve quality of life, according to data.
The researchers used this model to estimate the costs and quality-adjusted life-years (QALYs) of various screening tools for PsA. These tools included the Toronto Psoriatic Arthritis Screening (ToPAS) questionnaire, the Psoriasis Epidemiology Screening Tool (PEST), the Psoriatic Arthritis Screening and Evaluation (PASE) and the Early Arthritis for Psoriatic Patients (EARP). In addition, health status was defined via disability levels as assessed by the Health Assessment Questionnaire (HAQ).
Status changes were modelled based on annual disease progression of the average patient with PsA. The researchers used the model to estimate incremental costeffectiveness ratios (ICERs) and incremental net monetary benefits (INMBs). Lastly, they used sensitivity analyses to account for parameter uncertainty and test model assumptions.
According to the researchers, screening for PsA among patients with psoriasis was cost-effective compared with no screening. The EARP questionnaire demonstrated the lowest total cost, at $2,000 per patient per year saved compared with no screening, as well as the highest total QALYs, with an additional 0.18 per patient compared with no screening. These results were most sensitive to test accuracy and DMARD efficacy. Not screening for PsA was costeffective — at $50,000 per qualityadjusted lifeyears — compared with screening only when DMARDs failed to slow disease progression.
“This analysis shows that screening for PsA in psoriasis patients with self-administered questionnaires was cost-effective compared to ‘no screening,’” Iragorri and colleagues wrote. “Although the screening questionnaires were similar in terms of accuracy and cost, the EARP represented the best strategy due to slightly better accuracy.”
“Implementing a PsA screening program in Canada would be cost-savings over a 40-year time horizon relative to ‘no screening,’” they added. “Since the average time in biologic therapy per patient is expected to be reduced, the Canadian Health Care System would save around $220 million per year ($2,000 per patient) while improving quality of life.” – by Jason Laday
Disclosure: The researchers report funding from the National Institute for Health Research.