A systematic review of the effectiveness of adalimumab

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192 Appendix 10 TABLE 113 Variation 5: TNF inhibitors last (20,000 patients) Option Cost (£) QSE QALYs QSE Adal 38,154 224 1.6229 0.0230 Etan 51,491 271 2.8279 0.0280 Adal+MTX 37,604 223 1.9000 0.0234 Etan+MTX 51,024 270 2.7969 0.0282 Infl+MTX 37,743 213 1.6469 0.0235 Base 3,258 12 0.7532 0.0194 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 34,896 223 0.8697 0.0163 Etan – Base 48,233 269 2.0746 0.0237 Ad+M – Base 34,346 221 1.1468 0.0174 Et+M – Base 47,766 267 2.0437 0.0243 In+M – Base 34,485 212 0.8937 0.0172 Adal – Ad+M 550 305 –0.2771 0.0207 Etan – Et+M 467 360 0.0309 0.0311 Etan – Adal 13,338 335 1.2049 0.0258 Et+M – Ad+M 13,420 334 0.8970 0.0272 In+M – Ad+M 139 298 –0.2530 0.0214 Et+M – In+M 13,281 329 1.1500 0.0269 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 40,100 38,600 to 41,800 Etan – Base 23,200 22,700 to 23,900 Ad+M – Base 30,000 29,000 to 31,000 Et+M – Base 23,400 22,800 to 24,000 In+M – Base 38,600 37,100 to 40,200 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 11,100 10,300 to 11,800 Et+M – Ad+M 15,000 13,900 to 16,200 In+M – Ad+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 11,500 10,800 to 12,300 Variation 6 In this variation, a mortality ratio <strong>of</strong> 2.73 HAQ was assumed, as reported by Sokka and colleagues. 199 TABLE 114 Variation 6: TNF inhibitors first (200,000 patients) Option Cost (£) QSE QALYs QSE Adal 45,580 69 7.9578 0.0116 Etan 58,199 84 8.2524 0.0121 Adal+MTX 46,298 71 7.7037 0.0110 Etan+MTX 58,780 85 8.0276 0.0116 Infl+MTX 45,229 67 7.5142 0.0110 Base 13,334 15 7.4406 0.0107 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 32,246 68 0.5172 0.0113 Etan – Base 44,866 81 0.8118 0.0116 Ad+M – Base 32,965 69 0.2631 0.0110 Et+M – Base 45,447 82 0.5870 0.0114 In+M – Base 31,896 65 0.0737 0.0109 Ad+M – Adal 718 93 –0.2541 0.0113 Et+M – Etan 581 109 –0.2248 0.0121 continued
TABLE 114 Variation 6: TNF inhibitors first (200,000 patients) (cont’d) © Queen’s Printer and Controller <strong>of</strong> HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 Etan – Adal 12,620 101 0.2947 0.0119 Et+M – Ad+M 12,482 103 0.3239 0.0115 Ad+M – In+M 1,069 92 0.1895 0.0110 Et+M – In+M 13,551 101 0.5134 0.0115 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 62,300 59,700 to 65,200 Etan – Base 55,300 53,700 to 56,900 Ad+M – Base 125,000 116,000 to 137,000 Et+M – Base 77,400 74,500 to 80,600 In+M – Base 433,000 334,000 to 615,000 Ad+M – Adal Adal alone dominates Adal+MTX Et+M – Etan Etan alone dominates Etan+MTX Etan – Adal 42,800 39,600 to 46,700 Et+M – Ad+M 38,500 35,900 to 41,600 Ad+M – In+M 5,640 4,470 to 6,810 Et+M – In+M 26,400 25,200 to 27,700 TABLE 115 Variation 6: TNF inhibitors third (early RA values) (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 44,583 95 5.9748 0.0143 Etan 56,078 114 6.4647 0.0153 Adal+MTX 45,074 95 6.1281 0.0143 Etan+MTX 56,534 115 6.5723 0.0153 Infl+MTX 44,746 91 6.1093 0.0142 Base 14,431 22 5.1390 0.0129 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 30,152 92 0.8358 0.0140 Etan – Base 41,647 110 1.3256 0.0149 Ad+M – Base 30,643 93 0.9890 0.0140 Et+M – Base 42,103 111 1.4333 0.0150 In+M – Base 30,315 89 0.9703 0.0140 Ad+M – Adal 492 125 0.1533 0.0148 Et+M – Etan 456 147 0.1076 0.0163 Etan – Adal 11,495 136 0.4899 0.0154 Et+M – Ad+M 11,460 138 0.4442 0.0155 Ad+M – In+M 328 123 0.0188 0.0148 Et+M – In+M 11,788 135 0.4630 0.0155 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 36,100 34,900 to 37,300 Etan – Base 31,400 30,700 to 32,200 Ad+M – Base 31,000 30,100 to 31,900 Et+M – Base 29,400 28,800 to 30,000 In+M – Base 31,200 30,300 to 32,200 Ad+M – Adal 3,210 1,460 to 4,950 Et+M – Etan 4,240 1,220 to 7,260 Etan – Adal 23,500 22,000 to 25,200 Et+M – Ad+M 25,800 24,000 to 27,900 Ad+M – In+M Adal+MTX more costly than Infl+MTX; diff. QALY not significant Et+M – In+M 25,500 23,800 to 27,400 193
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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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tumor necrosis factor therapy in th
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arthritis: a 12-week, double-blind,
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171. Geborek P, Crnkic M, Petersson
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216. Schotte H, Willeke P, Mickholz
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The Health Assessment Questionnaire
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A systematic review of the effectiveness of adalimumab

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