A systematic review of the effectiveness of adalimumab

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112 Health economics TABLE 68 Sensitivity analyses: TNF inhibitors in last place Scenario Adal – Base Etan – Base Adal+MTX – Etan+MTX – Infl+MTX – Base Base Base Base case 40,100 23,700 29,700 23,800 37,900 No HAQ progression on TNF inhibitors 27,100 18,100 22,100 18,000 25,700 Slow HAQ progression on all DMARDs 39,500 24,400 30,500 24,900 37,600 Slow HAQ progression on all treatments 64,100 33,400 43,000 34,000 60,500 Fast HAQ progression on all treatments 58,300 30,300 39,400 30,000 53,300 No effect of HAQ on mortality 40,100 23,200 30,000 23,400 38,600 Mortality ratio 2.73 per unit HAQ 37,500 23,000 29,500 23,100 34,900 Effectiveness of conventional DMARDs down 50% 39,500 23,900 29,800 23,800 37,400 Effectiveness of conventional DMARDs up 50% 38,900 23,600 29,400 23,900 38,200 Survival times on conventional DMARDs down 50% 38,500 23,700 28,900 24,000 37,700 Survival times on conventional DMARDs up 50% 39,500 23,700 30,300 23,600 38,800 Survival times on TNF inhibitors down 50% 43,800 24,700 32,800 25,700 43,500 Survival times on TNF inhibitors up 50% 37,200 22,800 28,900 23,000 36,600 Review at 12 weeks 39,700 23,300 29,400 23,900 37,800 Short-term quitters on TNF inhibitors down 50% 40,800 23,900 30,200 24,100 38,400 Short-term quitters on TNF inhibitors up 50% 39,000 23,400 29,400 23,700 37,400 Short-term quitters on conventional DMARDs down 50% 39,300 23,500 29,500 23,800 37,400 Short-term quitters on conventional DMARDs up 50% 38,300 23,900 29,800 24,000 36,500 Include offset costs 38,400 22,300 27,900 22,400 36,100
The substantial economic impact of RA in terms of direct and indirect costs has been highlighted elsewhere in this report. Studies indicate a great range of potential costs that cannot readily be explained by socioeconomic or clinical factors. However, it is apparent that a minority of patients may account for a great proportion of the direct medical costs. Costs incurred by individuals, in a cohort of early Chapter 5 Implications for other parties © Queen’s Printer and Controller of HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 arthritis patients, are similar to costs incurred by healthcare services. Costs incurred by family and friends in terms of forgone paid work, forgone leisure time and other factors greatly exceed costs incurred by individuals and healthcare services. Clearly, this could have an impact on the quality of life of patients and carers. Further, physical disability resulting in difficulties in self-care, and work disability has implications for PSS. 113
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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
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58 TABLE 13 Quality of included RCT
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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 and 124: TABLE 59 Third TNF inhibitor follow
Page 125 and 126: TABLE 65 Sensitivity analyses: TNF
Page 127: TABLE 67 Sensitivity analyses: TNF
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
Page 177 and 178: 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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A systematic review of the effectiveness of adalimumab

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