A systematic review of the effectiveness of adalimumab

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182 Appendix 10 Variation 2 For this variation, it was assumed that HAQ progression on all active treatments was at 0.03 per year. TABLE 98 Variation 2: TNF inhibitors first (200,000 patients) Option Cost (£) QSE QALYs QSE Adal 49,443 72 9.5963 0.0130 Etan 63,882 87 9.8239 0.0132 Adal+MTX 49,787 73 9.0930 0.0122 Etan+MTX 64,093 88 9.3620 0.0122 Infl+MTX 49,186 70 8.9392 0.0122 Base 15,420 15 9.2826 0.0125 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 34,023 71 0.3137 0.0128 Etan – Base 48,462 85 0.5413 0.0130 Ad+M – Base 34,367 72 –0.1896 0.0125 Et+M – Base 48,673 86 0.0794 0.0128 In+M – Base 33,766 68 –0.3433 0.0125 Ad+M – Adal 345 98 –0.5033 0.0127 Et+M – Etan 211 116 –0.4619 0.0131 Etan – Adal 14,440 107 0.2276 0.0131 Et+M – Ad+M 14,306 109 0.2690 0.0126 Ad+M – In+M 601 97 0.1537 0.0123 Et+M – In+M 14,907 107 0.4228 0.0126 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 108,000 100,000 to 118,000 Etan – Base 89,500 85,400 to 94,100 Ad+M – Base Base dominates Adal+MTX Et+M – Base 613,000 463,000 to 906,000 In+M – Base Base dominates Infl+MTX Ad+M – Adal Adal alone dominates Adal+MTX Et+M – Etan Etan alone more effective than Etan+MTX; diff. cost not significant Etan – Adal 63,500 56,900 to 71,800 Et+M – Ad+M 53,200 48,600 to 58,700 Ad+M – In+M 3,910 2,510 to 5,310 Et+M – In+M 35,300 33,200 to 37,600 TABLE 99 Variation 2: TNF inhibitors third (early RA values) (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 48,569 98 6.9994 0.0159 Etan 61,074 119 7.4020 0.0166 Adal+MTX 48,640 98 7.1398 0.0159 Etan+MTX 61,329 119 7.4999 0.0166 Infl+MTX 48,158 94 7.0644 0.0158 Base 16,590 23 6.2559 0.0151 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 31,979 96 0.7435 0.0155 Etan – Base 44,484 116 1.1462 0.0161 Ad+M – Base 32,049 96 0.8840 0.0156 Et+M – Base 44,738 116 1.2441 0.0162 In+M – Base 31,567 92 0.8086 0.0155 Ad+M – Adal 70 131 0.1405 0.0160 Et+M – Etan 255 154 0.0979 0.0171 Etan – Adal 12,505 144 0.4027 0.0165 continued
TABLE 99 Variation 2: TNF inhibitors third (early RA values) (100,000 patients) (cont’d) © Queen’s Printer and Controller <strong>of</strong> HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 Et+M – Ad+M 12,689 144 0.3601 0.0166 Ad+M – In+M 482 128 0.0754 0.0160 Et+M – In+M 13,171 141 0.4355 0.0165 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 43,000 41,300 to 44,900 Etan – Base 38,800 37,700 to 40,000 Ad+M – Base 36,300 35,000 to 37,600 Et+M – Base 36,000 35,000 to 36,900 In+M – Base 39,000 37,600 to 40,600 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Etan+MTX more effective than Etan alone; diff. cost not significant Etan – Adal 31,100 28,600 to 33,900 Et+M – Ad+M 35,200 32,200 to 38,900 Ad+M – In+M 6,390 2,050 to 10,700 Et+M – In+M 30,200 28,000 to 32,800 TABLE 100 Variation 2: TNF inhibitors third (late RA values) (400,000 patients) Option Cost (£) QSE QALYs QSE Adal 47,823 49 6.3067 0.0079 Etan 60,550 59 6.8904 0.0082 Adal+MTX 48,056 49 6.5602 0.0079 Etan+MTX 60,660 59 6.8825 0.0082 Infl+MTX 47,505 47 6.3152 0.0079 Base 16,546 11 6.2482 0.0075 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 31,277 48 0.0584 0.0075 Etan – Base 44,004 58 0.6421 0.0079 Ad+M – Base 31,510 48 0.3119 0.0076 Et+M – Base 44,114 58 0.6343 0.0079 In+M – Base 30,959 46 0.0669 0.0076 Ad+M – Adal 233 65 0.2535 0.0075 Et+M – Etan 111 77 –0.0079 0.0082 Etan – Adal 12,727 71 0.5837 0.0078 Et+M – Ad+M 12,605 71 0.3223 0.0079 Ad+M – In+M 551 63 0.2450 0.0076 Et+M – In+M 13,155 70 0.5673 0.0079 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 535,000 426,000 to 721,000 Etan – Base 68,500 66,900 to 70,300 Ad+M – Base 101,000 96,300 to 106,000 Et+M – Base 69,600 67,800 to 71,300 In+M – Base 462,000 377,000 to 597,000 Ad+M – Adal 920 407 to 1,430 Et+M – Etan Comparison is inconclusive Etan – Adal 21,800 21,200 to 22,500 Et+M – Ad+M 39,100 37,200 to 41,200 Ad+M – In+M 2,250 1,710 to 2,780 Et+M – In+M 23,200 22,500 to 23,900 183
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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
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62 Effectiveness significant advant
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64 Effectiveness Review: Infliximab
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66 Effectiveness Review: Infliximab
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68 Effectiveness FIGURE 44 Malignan
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70 TABLE 17 Effectiveness Summary o
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Summary of review of existing econo
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TABLE 20 Summary of published ICERs
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TABLE 21 Published etanercept econo
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TABLE 23 Published economic analyse
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TABLE 25 Treatment sequences: adali
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management of RA, i.e. 1st and 2nd
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To estimate the long-term consequen
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TABLE 32 TNF inhibitors as last act
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TABLE 34 Basic structure of the mod
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een quit on grounds of toxicity, ad
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TABLE 39 Strategy set: adalimumab a
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TABLE 43 Beta distributions for HAQ
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TABLE 44 Early cessation of DMARDs:
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TABLE 46 Unit costs for tests and v
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following properties, according to
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TABLE 52 Base case: TNF inhibitors
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TABLE 54 Base case: TNF inhibitors
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TABLE 59 Third TNF inhibitor follow
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TABLE 65 Sensitivity analyses: TNF
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TABLE 67 Sensitivity analyses: TNF
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The substantial economic impact of
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Summary Effectiveness: principal fi
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inhibitors, although the incrementa
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introduce bias which generally exag
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Adalimumab, etanercept and inflixim
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1. Jobanputra P, Barton P, Bryan S,
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46. Young A, Dixey J, Cox N, Davies
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Page 187 and 188: TABLE 85 Bansback et al., 2005 166
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Page 195 and 196: Extensive sensitivity analysis was
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A systematic review of the effectiveness of adalimumab

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