Implications for research

The ERG believes that some uncertainty still remains due to a lack of robust evidence on some key model parameters. Further research is needed into:

 The natural history of HAQ score change.

 Rebound to HAQ on withdrawal from treatment. Further evidence is required to identify which scenario is most likely to reflect clinical reality.

 HAQ and PASI related costs. The limitations of these data were fully discussed in the previous submission and no attempt has been made to address the limitations.

 A properly powered trial of ustekinumab versus TNFα inhibitor therapy is required. Any such trial should clearly distinguish between prior anti-TNFα experience and anti-TNFα class

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10 Appendices