A conceptual modelling framework for estimating the consequences of psoriatic arthritis disease domains

ObjectiveCharacterize psoriatic arthritis (PsA) heterogeneity and develop a conceptual framework to model the clinical and economic value of treatments on key PsA disease domains. MethodsWe performed a narrative literature review to identify the key PsA disease domains and outcome measures for these and explore the existing evidence base of clinical and economic evaluations of current PsA treatments on key disease domains. We propose an economic modelling framework that could estimate the economic value of PsA treatments on disease domains. ResultsOur literature review identified the following key PsA disease domains: peripheral arthritis, dactylitis, enthesitis, psoriatic spondylitis, skin, and nail lesions, and associated key outcome measures. Our review of the literature, including clinical guidelines, suggests that the evidence base of specific treatment performance on modulating outcomes for a given domain was not strong. We propose an economic modelling framework to estimate the economic value of treatments for addressing specific PsA disease domains. Given existing evidence gaps, we would recommend a cohort-level model with a lifetime horizon, to estimate total social value as well as the cost per outcome and change in cost per symptom avoided. The significant patient heterogeneity in PsA would suggest an individual/patient-level simulation but is likely not feasible with existing data. ConclusionsPsA is a heterogeneous disease, with a number of key disease domains and variable presentation. A better understanding of the performance of treatments on given disease domains would help support patients, providers, payers, HTAs, and health care policy makers in making personalized treatment decisions. Key messagesO_LIPsoriatic arthritis is a heterogeneous disease, with patients presenting a variety of disease manifestations. C_LIO_LIBetter understanding of the interaction between manifestations and treatments could help inform patient and physician decision making. C_LIO_LIThe proposed model framework would help inform value-based, personalized treatment decisions in PsA. C_LI