A systematic review of the effectiveness of adalimumab

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108 Health economics TABLE 63 Third TNF inhibitor following infliximab and adalimumab (20,000 patients) Option Cost (£) QSE QALYs QSE Etan 56,788 257 5.2257 0.0318 Base 15,434 50 4.4850 0.0280 Comparison Diff. cost (£) QSE Diff. QALY QSE Etan – Base 41,354 248 0.7407 0.0319 Comparison ICER (£ per QALY) Quasi-CI Etan – Base 55,800 51,400 to 61,100 TABLE 64 Third TNF inhibitor following infliximab and etanercept (10,000 patients) Option Cost (£) QSE QALYs QSE Adal 44,336 66 4.3794 0.0093 Base 15,122 16 4.3218 0.0087 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 29,214 64 0.0577 0.0093 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 506,000 383,000 to 749,000
TABLE 65 Sensitivity analyses: TNF inhibitors at the start © Queen’s Printer and Controller of HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 Scenario Adal – Base Etan – Base Adal+MTX – Etan+MTX – Infl+MTX – Base Base Base Base case 52,600 49,400 171,000 78,100 654,000 No HAQ progression on TNF inhibitors 27,000 23,500 37,600 28,000 46,100 Slow HAQ progression on all DMARDs 108,000 89,500 Base 613,000 Base Slow HAQ progression on all treatments 122,000 109,000 Base 645,000 Base Fast HAQ progression on all treatments 92,500 99,500 Base 343,000 Base No effect of HAQ on mortality 50,500 46,500 211,000 80,700 1,910,000 Mortality ratio 2.73 per unit HAQ 62,300 55,300 125,000 77,400 433,000 Effectiveness of conventional DMARDs down 50% 34,700 30,400 39,300 32,100 44,600 Effectiveness of conventional DMARDs up 50% 115,000 119,000 Base Base Base Survival times on conventional DMARDs down 50% 40,300 36,900 104,000 55,600 227,000 Survival times on conventional DMARDs up 50% 60,500 56,900 151,000 86,800 605,000 Survival times on TNF inhibitors down 50% 53,400 48,300 Base 177,000 Base Survival times on TNF inhibitors up 50% 54,900 50,700 92,300 66,800 166,000 Review at 12 weeks 53,500 48,900 195,000 81,500 2,190,000 Short-term quitters on TNF inhibitors down 50% 56,000 50,400 167,000 79,600 833,000 Short-term quitters on TNF inhibitors up 50% 50,500 48,100 161,000 75,700 518,000 Short-term quitters on conventional DMARDs down 50% 53,400 49,500 139,000 74,700 345,000 Short-term quitters on conventional DMARDs up 50% 50,800 47,000 198,000 79,800 2,950,000 Include offset costs 53,100 48,100 166,000 77,900 827,000 Base: baseline option dominates option with TNF inhibitor. 109
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A systematic review of the effectiv
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A systematic review of the effectiv
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Objectives: This report reviews the
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Glossary and list of abbreviations
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viii Glossary and list of abbreviat
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Background Rheumatoid arthritis (RA
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increased risk of serious infection
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Summary RA is a common, chronic, in
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(IL-2) and interleukin-6 (IL-6), pr
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Assessment of response to DMARDs Re
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combination with methotrexate or al
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disease between clinic appointments
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14 Effectiveness in juvenile arthri
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16 Effectiveness adalimumab plus me
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18 Effectiveness Monoclonal Antibod
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20 TABLE 1 Description of included
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22 TABLE 2 Quality of included RCTs
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24 Effectiveness change in modified
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26 Effectiveness TABLE 4 Meta-analy
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28 Effectiveness Review: Adalimumab
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30 Effectiveness Review: Adalimumab
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32 TABLE 6 Effectiveness Descriptio
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34 TABLE 6 Effectiveness Descriptio
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36 TABLE 7 Effectiveness Quality of
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38 Effectiveness etanercept trials.
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40 Effectiveness TABLE 9 Summary of
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42 Effectiveness Review: Etanercept
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54 Effectiveness TABLE 11 Summary o
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56 TABLE 12 Description of included
Page 74 and 75: 58 TABLE 13 Quality of included RCT
Page 76 and 77: 60 Effectiveness per week and escal
Page 78 and 79: 62 Effectiveness significant advant
Page 80 and 81: 64 Effectiveness Review: Infliximab
Page 82 and 83: 66 Effectiveness Review: Infliximab
Page 84 and 85: 68 Effectiveness FIGURE 44 Malignan
Page 86 and 87: 70 TABLE 17 Effectiveness Summary o
Page 89 and 90: Summary of review of existing econo
Page 91 and 92: TABLE 20 Summary of published ICERs
Page 93 and 94: TABLE 21 Published etanercept econo
Page 95 and 96: TABLE 23 Published economic analyse
Page 97 and 98: TABLE 25 Treatment sequences: adali
Page 99 and 100: management of RA, i.e. 1st and 2nd
Page 101 and 102: To estimate the long-term consequen
Page 103 and 104: TABLE 32 TNF inhibitors as last act
Page 105 and 106: TABLE 34 Basic structure of the mod
Page 107 and 108: een quit on grounds of toxicity, ad
Page 109 and 110: TABLE 39 Strategy set: adalimumab a
Page 111 and 112: TABLE 43 Beta distributions for HAQ
Page 113 and 114: TABLE 44 Early cessation of DMARDs:
Page 115 and 116: TABLE 46 Unit costs for tests and v
Page 117 and 118: following properties, according to
Page 119 and 120: TABLE 52 Base case: TNF inhibitors
Page 121 and 122: TABLE 54 Base case: TNF inhibitors
Page 123: TABLE 59 Third TNF inhibitor follow
Page 127 and 128: TABLE 67 Sensitivity analyses: TNF
Page 129: The substantial economic impact of
Page 133 and 134: Summary Effectiveness: principal fi
Page 135 and 136: inhibitors, although the incrementa
Page 137 and 138: introduce bias which generally exag
Page 139: Adalimumab, etanercept and inflixim
Page 143 and 144: 1. Jobanputra P, Barton P, Bryan S,
Page 145 and 146: 46. Young A, Dixey J, Cox N, Davies
Page 147 and 148: tumor necrosis factor therapy in th
Page 149 and 150: arthritis: a 12-week, double-blind,
Page 151 and 152: 171. Geborek P, Crnkic M, Petersson
Page 153 and 154: 216. Schotte H, Willeke P, Mickholz
Page 155 and 156: The Health Assessment Questionnaire
Page 157 and 158: Cochrane Library (CENTRAL) 2005 Iss
Page 159 and 160: Appendix 3 © Queen’s Printer and
Page 161: TABLE 69 Studies excluded from clin
Page 164 and 165: 148 Appendix 4 TABLE 71 Meta-analys
Page 166 and 167: 150 Appendix 4 TABLE 73 Meta-analys
Page 168 and 169: 152 Appendix 4 Infliximab versus pl
Page 170 and 171: 154 Appendix 4 Infliximab plus MTX
Page 173: Ovid MEDLINE(R) 1966 to February we
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Appendix 8 © Queen’s Printer and
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TABLE 79 Wong et al., 2002 161 © Q
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TABLE 80 Kobelt et al., 2003 162 (c
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TABLE 82 Brennan et al., 2004 160
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TABLE 85 Bansback et al., 2005 166
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176 Appendix 9 TABLE 89 Strategy se
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Extensive sensitivity analysis was
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TABLE 96 Variation 1: TNF inhibitor
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TABLE 99 Variation 2: TNF inhibitor
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TABLE 102 Variation 3: TNF inhibito
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TABLE 132 Variation 10: TNF inhibit
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Volume 1, 1997 No. 1 Home parentera
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No. 3 Screening for sickle cell dis
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No. 25 A rapid and systematic revie
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No. 11 First and second trimester a
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No. 23 Clinical effectiveness and c
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No. 28 Outcomes of electrically sti
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No. 28 Adefovir dipivoxil and pegyl
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246 Health Technology Assessment Pr
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A systematic review of the effectiveness of adalimumab

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