A systematic review of the effectiveness of adalimumab

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Appendix 10
Variation 14
In this variation, the probability of quitting TNF inhibitors in the short term was reduced by 50%.
TABLE 146 Variation 14: TNF inhibitors first (1,000,000 patients)
Option Cost (£) QSE QALYs QSE
Adal 50,542 32 8.9468 0.0053
Etan 64,418 39 9.2912 0.0055
Adal+MTX 50,660 33 8.5290 0.0051
Etan+MTX 64,608 39 8.9364 0.0054
Infl+MTX 49,980 31 8.3593 0.0051
Base 15,336 7 8.3177 0.0050
Comparison Diff. cost (£) QSE Diff. QALY QSE
Adal – Base 35,206 32 0.6291 0.0054
Etan – Base 49,083 38 0.9735 0.0055
Ad+M – Base 35,325 32 0.2112 0.0052
Et+M – Base 49,273 38 0.6187 0.0054
In+M – Base 34,645 30 0.0416 0.0052
Ad+M – Adal 118 44 –0.4178 0.0054
Et+M – Etan 190 52 –0.3547 0.0057
Etan – Adal 13,876 48 0.3444 0.0056
Et+M – Ad+M 13,948 48 0.4075 0.0055
Ad+M – In+M 680 43 0.1697 0.0052
Et+M – In+M 14,628 47 0.5771 0.0055
Comparison ICER (£ per QALY) Quasi-CI
Adal – Base 56,000 55,000 to 56,900
Etan – Base 50,400 49,900 to 51,000
Ad+M – Base 167,000 159,000 to 176,000
Et+M – Base 79,600 78,300 to 81,100
In+M – Base 833,000 666,000 to 1,110,000
Ad+M – Adal Adal alone dominates Adal+MTX
Et+M – Etan Etan alone dominates Etan+MTX
Etan – Adal 40,300 39,000 to 41,700
Et+M – Ad+M 34,200 33,300 to 35,200
Ad+M – In+M 4,010 3,440 to 4,570
Et+M – In+M 25,300 24,800 to 25,900
TABLE 147 Variation 14: TNF inhibitors third (early RA values) (100,000 patients)
Option Cost (£) QSE QALYs QSE
Adal 49,271 98 6.3330 0.0150
Etan 61,438 119 6.8631 0.0159
Adal+MTX 49,332 98 6.4770 0.0149
Etan+MTX 61,790 119 6.9684 0.0160
Infl+MTX 49,095 95 6.4474 0.0149
Base 16,462 23 5.4046 0.0138
Comparison Diff. cost (£) QSE Diff. QALY QSE
Adal – Base 32,809 96 0.9284 0.0148
Etan – Base 44,977 115 1.4585 0.0157
Ad+M – Base 32,871 96 1.0724 0.0148
Et+M – Base 45,329 116 1.5638 0.0157
In+M – Base 32,633 92 1.0429 0.0148
Ad+M – Adal 62 130 0.1440 0.0154
Et+M – Etan 352 154 0.1053 0.0169
Etan – Adal 12,168 143 0.5301 0.0162
continued