A systematic review of the effectiveness of adalimumab

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206 Appendix 10 Variation 11 In this variation, <strong>the</strong> long-term survival times on TNF inhibitors were reduced by 50%. TABLE 134 Variation 11: TNF inhibitors first (200,000 patients) Option Cost (£) QSE QALYs QSE Adal 38,822 54 8.7520 0.0115 Etan 51,459 73 9.0597 0.0119 Adal+MTX 38,771 54 8.1127 0.0110 Etan+MTX 51,404 74 8.5160 0.0115 Infl+MTX 38,772 52 8.0226 0.0110 Base 15,356 15 8.3124 0.0111 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 23,466 53 0.4396 0.0118 Etan – Base 36,103 72 0.7473 0.0121 Ad+M – Base 23,415 54 –0.1997 0.0115 Et+M – Base 36,048 72 0.2036 0.0118 In+M – Base 23,416 51 –0.2898 0.0115 Adal – Ad+M 50 73 0.6393 0.0116 Etan – Et+M 55 99 0.5437 0.0121 Etan – Adal 12,637 87 0.3077 0.0121 Et+M – Ad+M 12,632 88 0.4033 0.0116 In+M – Ad+M 1 72 –0.0901 0.0113 Et+M – In+M 12,632 87 0.4934 0.0116 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 53,400 50,700 to 56,400 Etan – Base 48,300 46,800 to 49,900 Ad+M – Base Base dominates Adal+MTX Et+M – Base 177,000 159,000 to 200,000 In+M – Base Base dominates Infl+MTX Adal – Ad+M Adal alone more effective than Adal+MTX; diff. cost not significant Et+M – Etan Etan alone more effective than Etan+MTX; diff. cost not significant Etan – Adal 41,100 38,000 to 44,600 Et+M – Ad+M 31,300 29,600 to 33,300 In+M – Ad+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 25,600 24,400 to 26,900 TABLE 135 Variation 11: TNF inhibitors third (early RA values) (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 38,639 74 5.9879 0.0143 Etan 50,057 100 6.4353 0.0150 Adal+MTX 38,722 74 6.0756 0.0143 Etan+MTX 50,158 100 6.5242 0.0151 Infl+MTX 38,801 71 6.0527 0.0143 Base 16,468 23 5.3842 0.0137 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 22,171 73 0.6037 0.0142 Etan – Base 33,589 97 1.0511 0.0149 Ad+M – Base 22,254 73 0.6914 0.0143 Et+M – Base 33,690 97 1.1400 0.0149 In+M – Base 22,332 70 0.6685 0.0142 Ad+M – Adal 83 99 0.0877 0.0146 Et+M – Etan 101 132 0.0889 0.0157 Etan – Adal 11,418 117 0.4474 0.0151 continued
TABLE 135 Variation 11: 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 11,436 117 0.4486 0.0152 In+M – Ad+M 78 96 –0.0229 0.0145 Et+M – In+M 11,357 116 0.4715 0.0152 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 36,700 35,100 to 38,600 Etan – Base 32,000 31,100 to 32,900 Ad+M – Base 32,200 30,900 to 33,600 Et+M – Base 29,600 28,800 to 30,400 In+M – Base 33,400 32,000 to 34,900 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 25,500 23,800 to 27,500 Et+M – Ad+M 25,500 23,800 to 27,400 In+M – Ad+M Comparison is inconclusive Et+M – In+M 24,100 22,600 to 25,800 TABLE 136 Variation 11: TNF inhibitors third (late RA values) (200,000 patients) Option Cost (£) QSE QALYs QSE Adal 38,431 52 5.5641 0.0101 Etan 49,697 70 6.0961 0.0106 Adal+MTX 38,502 52 5.7344 0.0101 Etan+MTX 49,806 70 6.0959 0.0106 Infl+MTX 38,541 50 5.5583 0.0101 Base 16,490 16 5.3809 0.0097 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 21,940 51 0.1832 0.0099 Etan – Base 33,207 69 0.7153 0.0103 Ad+M – Base 22,012 51 0.3536 0.0099 Et+M – Base 33,316 69 0.7150 0.0103 In+M – Base 22,050 49 0.1774 0.0099 Ad+M – Adal 72 69 0.1704 0.0099 Et+M – Etan 109 93 –0.0003 0.0107 Etan – Adal 11,266 82 0.5321 0.0102 Et+M – Ad+M 11,304 82 0.3614 0.0104 In+M – Ad+M 38 68 –0.1762 0.0099 Et+M – In+M 11,265 81 0.5376 0.0104 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 120,000 108,000 to 134,000 Etan – Base 46,400 45,100 to 47,800 Ad+M – Base 62,300 58,900 to 66,000 Et+M – Base 46,600 45,300 to 48,000 In+M – Base 124,000 112,000 to 140,000 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 21,200 20,300 to 22,100 Et+M – Ad+M 31,300 29,500 to 33,200 In+M – Ad+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 21,000 20,100 to 21,900 207
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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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Cochrane Library (CENTRAL) 2005 Iss
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Appendix 3 © Queen’s Printer and
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TABLE 69 Studies excluded from clin
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148 Appendix 4 TABLE 71 Meta-analys
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150 Appendix 4 TABLE 73 Meta-analys
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152 Appendix 4 Infliximab versus pl
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154 Appendix 4 Infliximab plus MTX
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A systematic review of the effectiveness of adalimumab

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