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Rodgers M, Epstein D, Bojke L, et al. Etanercept, Infliximab and Adalimumab for the Treatment of Psoriatic Arthritis: A Systematic Review and Economic Evaluation. Southampton (UK): NIHR Journals Library; 2011 Feb. (Health Technology Assessment, No. 15.10.)

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Etanercept, Infliximab and Adalimumab for the Treatment of Psoriatic Arthritis: A Systematic Review and Economic Evaluation.

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5Assessment of factors relevant to the NHS and other parties

The results of this technology assessment have some implications for clinical practice. At present, most patients with PsA who receive biologic therapy are managed by a rheumatologist. However, patients with PsA primarily concerned with improvements in their skin may benefit from being managed by a dermatologist who can tailor any ongoing topical therapy appropriately. Some patients with severe skin and joint disease may need dual management of both specialties, although it has implications in terms of additional administration, costs and communication between the specialties and primary care.

For patients with joint disease who respond to biologic treatment, potential cost savings might include reduced need for contact with services (e.g. physiotherapy) and monitoring costs for certain DMARDs. For patients responding in terms of skin disease, there may be the potential for avoiding inpatient admissions resulting from severe psoriasis.

There is a choice of measures available for assessing joint response (ACR or PsARC). BSR guidelines currently recommend PsARC, but also suggest this is supplemented with measures of HAQ, ESR and CRP. The choice of outcome measure will therefore have resource use as well as methodological implications.

The mode of delivery varies among the biologics included in this evaluation. Provision of infliximab requires the treatment centre to have the appropriate capacity in terms of staff and facilities to delivered scheduled i.v. infusions of the agent. In contrast, etanercept and adalimumab are delivered by self-administered injection. This may have short-term implications for initial training of patients, although with potential cost savings in the longer term.

As the rate of serious adverse events for these biologic agents has yet to be well established, all patients should be monitored by a specialist. In addition, relevant data for the BSRBR should be collected and appropriate measures for infection screening should be used.

The potential benefits of these agents on physical function and QoL might result in reduced demand on social services and carers, and the potential (although not yet fully demonstrated) for slowing disease progression could potentially reduce the demand for joint replacement surgery and associated services.

© 2011, Crown Copyright.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK109490

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