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This economic evaluation was performed to assess the cost-effectiveness of infliximab maintenance treatment at the licensed dose of [http://www.selleckchem.com/products/carfilzomib-pr-171.html Carfilzomib] 5 mg/kg in comparison with palliative care without infliximab and other TNF-�� inhibitors for the treatment of patients with active and progressive psoriatic arthritis who have had treatment failure with at least two DMARDs. A separate analysis was also performed for the subgroup of patients with psoriatic arthritis who demonstrated a significant psoriatic component at baseline, defined as psoriasis affecting body surface area (BSA) of at least 3%. The economic analysis focused on patients with active and progressive psoriatic arthritis, among whom two-thirds had significant psoriasis at baseline, with the patient population being based on that studied in infliximab clinical trials (IMPACT and IMPACT2) [7]?and?[8]. The effect of a TNF-�� inhibitor on the rheumatic component of the disease across all patients was estimated by means of the Health Assessment Questionnaire (HAQ) score. In the subgroup with significant psoriasis at baseline, the effect on the psoriatic component of the disease was also estimated with psoriasis area severity index (PASI). For the a third of the patients with psoriatic arthritis who showed no clinically significant psoriasis (affected BSA [https://en.wikipedia.org/wiki/Cefaloridine Cefaloridine] 0�C3) was assumed at baseline. For the two-thirds with significant psoriasis at baseline, a mean PASI score of 11 (range 0�C32) was assumed. Patients entered the model at the age of 45 years, and 50% were men. The analysis compared four treatment alternatives. These included maintenance treatment with a TNF-�� inhibitor (infliximab, adalimumab, [http://www.selleckchem.com/products/VX-809.html VX809] or etanercept) followed by a sequence of nonbiologic DMARDs or palliative care comprising only nonbiologic DMARDs. The analysis was conducted with a time horizon of 40 years, and half-cycle correction was applied. The model structure in terms of the cohort flow is displayed in Figure 1 and is based on the model previously developed by Bravo Vergel et al. [9]. The main distinction between our model and that used previously is the explicit consideration of the psoriatic component of the condition. The model can be summarized as having a first cycle starting at 0 and running to 12 weeks, a second cycle of 13 to 24 weeks, and annual cycles thereafter. In contrast to the Bravo Vergel et al. model [9], a second cycle of 12 weeks stretching from week 13 to week 24 was included on the basis of trial analysis of infliximab trials suggesting that improvements in the rheumatic and psoriatic components of the disease continue beyond the initial 12 weeks. At the end of the first cycle, all patients were assessed for their Psoriatic Arthritis Response Criteria (PsARC) response.