A systematic review of the effectiveness of adalimumab

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226 Appendix 10 TABLE 164 Variation 18: TNF inhibitors third (late RA values) (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 58,576 109 5.5927 0.0147 Etan 70,549 129 6.3112 0.0156 Adal+MTX 58,583 107 5.8779 0.0147 Etan+MTX 70,423 128 6.2830 0.0157 Infl+MTX 58,374 105 5.6291 0.0148 Base 27,469 43 5.3622 0.0137 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 31,107 103 0.2305 0.0141 Etan – Base 43,080 121 0.9489 0.0151 Ad+M – Base 31,114 102 0.5156 0.0142 Et+M – Base 42,954 121 0.9208 0.0152 In+M – Base 30,906 99 0.2669 0.0142 Ad+M – Adal 7 136 0.2851 0.0144 Etan – Et+M 126 159 0.0281 0.0161 Etan – Adal 11,973 149 0.7184 0.0152 Et+M – Ad+M 11,840 148 0.4052 0.0153 Ad+M – In+M 209 134 0.2488 0.0145 Et+M – In+M 12,048 147 0.6540 0.0153 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 135,000 120,000 to 154,000 Etan – Base 45,400 44,000 to 46,900 Ad+M – Base 60,300 57,200 to 63,900 Et+M – Base 46,600 45,100 to 48,300 In+M – Base 116,000 105,000 to 130,000 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Etan – Et+M Comparison is inconclusive Etan – Adal 16,700 15,900 to 17,500 Et+M – Ad+M 29,200 27,100 to 31,800 Ad+M – In+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 18,400 17,500 to 19,500 TABLE 165 Variation 18: TNF inhibitors last (20,000 patients) Option Cost (£) QSE QALYs QSE Adal 50,104 239 1.8630 0.0220 Etan 61,587 282 2.9782 0.0267 Adal+MTX 49,663 234 2.1603 0.0223 Etan+MTX 61,732 283 2.9730 0.0271 Infl+MTX 50,066 231 1.9151 0.0226 Base 18,262 81 1.0336 0.0183 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 31,842 227 0.8293 0.0160 Etan – Base 43,325 267 1.9446 0.0228 Ad+M – Base 31,401 223 1.1267 0.0171 Et+M – Base 43,470 266 1.9393 0.0233 In+M – Base 31,804 220 0.8815 0.0169 Adal – Ad+M 440 303 –0.2974 0.0204 Et+M – Etan 144 352 –0.0053 0.0298 Etan – Adal 11,484 332 1.1153 0.0253 Et+M – Ad+M 12,068 330 0.8126 0.0264 In+M – Ad+M 402 297 –0.2452 0.0214 Et+M – In+M 11,666 325 1.0578 0.0262 continued
TABLE 165 Variation 18: TNF inhibitors last (20,000 patients) (cont’d) © Queen’s Printer and Controller <strong>of</strong> HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 38,400 36,900 to 40,000 Etan – Base 22,300 21,700 to 22,900 Ad+M – Base 27,900 27,000 to 28,800 Et+M – Base 22,400 21,800 to 23,000 In+M – Base 36,100 34,700 to 37,600 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 10,300 9,540 to 11,100 Et+M – Ad+M 14,900 13,700 to 16,200 In+M – Ad+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 11,000 10,200 to 11,900 227
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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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Ovid MEDLINE(R) 1966 to February we
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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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A systematic review of the effectiveness of adalimumab

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