A systematic review of the effectiveness of adalimumab

More documents

Recommendations

Info

92 Health economics Strategies including two TNF inhibitors consecutively Here the relevant decision is, having used one TNF inhibitor, whether to use a second TNF inhibitor or to revert to conventional DMARDs. Only the case where the first TNF inhibitor is used as third line therapy is considered, and adalimumab and etanercept are considered only as single therapy. Any one of the three TNF inhibitors could be the first choice. Thus, there are three strategy sets to consider, each with three options. The first of these strategy sets (Table 38) starts with methotrexate, followed by sulfasalazine (with or without methotrexate) and then adalimumab. The divergence point comes immediately after adalimumab. Options 1 and 2 are to treat with etanercept and infliximab, respectively, if adalimumab fails and then continue the baseline strategy from leflunomide onwards. In the comparator, option 3, adalimumab is followed by leflunomide and the baseline strategy. The equivalent strategy sets for other choices of first TNF inhibitor are shown in Tables 87 and 88 (Appendix 9). Strategies including all three TNF inhibitors consecutively Here the relevant decision is, having used two TNF inhibitors, whether to use a third TNF inhibitor or to revert to conventional DMARDs. Again only the case where the first TNF inhibitor is used as third-line therapy is considered; that is, after sulfasalazine and methotrexate have been TABLE 38 Strategy set with adalimumab followed by another TNF inhibitor tried (according to current NICE guidance), and adalimumab and etanercept are considered only as single therapy. Any one of the three TNF inhibitors could be the first fixed choice, with either of the other two as the second fixed choice. Thus, there are six strategy sets to consider, each with two options. The strategy set shown in Table 39 starts with methotrexate, followed by sulfasalazine (with or without methotrexate) and then adalimumab followed by etanercept. The divergence point comes immediately after etanercept. Option 1 is to use infliximab after this and then continue the baseline strategy from leflunomide onwards; option 2 is to forgo infliximab and continue directly with leflunomide. The other five strategy sets, which are similar, are given in Tables 89–93, (Appendix 9). Data used in the BRAM The main source of data is the current review for TNF inhibitors and published literature for other data. Initial patient data Table 40 shows the initial age and sex distribution, based on UK data from Wiles et al. 172 The starting distribution of HAQ scores, shown in Table 41, is also based on Wiles. 172 Starting treatments In previous versions of the BRAM, the HAQ improvement (decrease) on starting any treatment Moves dependent on toxicity Treatment Always move to Relevant toxicity If toxic, move to Otherwise, move to MTX MTX SSZ MTX+SSZ SSZ Adal MTX+SSZ Adal Adal Divergence point Option 1 Etan Etan LEF Option 2 Infl+MTX Infl+MTX LEF Option 3 LEF LEF GST GST AZA AZA CyA CyA CyA or MTX DPen CyA+MTX CyA+MTX DPen DPen Pall
TABLE 39 Strategy set: adalimumab and etanercept possibly followed by infliximab was fixed as a multiple of 0.125. In this version, the HAQ improvement has been allowed to vary between individual patients in the model, and is modelled as a multiplier of the original HAQ. An example of the method used is shown here for the case of leflunomide. Data available were baseline HAQ mean 1.03 (SD 0.62) and HAQ improvement mean 0.48 (SD 0.5). 173 An Excel spreadsheet was set up to create a starting population of 10,000 virtual patients with HAQ scores drawn from a normal distribution with mean and standard deviation supplied by the TABLE 40 Initial age and gender distribution © Queen’s Printer and Controller of HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 user. Each generated HAQ score was converted to the nearest legitimate value (multiples of 0.125 in the range 0–3). The parameters supplied were adjusted to compensate for the effect of this conversion, so that the mean and standard deviation of the population generated correspond to the data. A beta distribution was found to match the given mean and standard deviation for HAQ improvement. The parameters are shown in Table 42, while Figure 47 displays the simulated population. Each square within the graph represents a possible pair of values of starting HAQ and HAQ on treatment: the darker the Age (years) 15–24 25–34 35–44 45–54 55–64 65–74 75–84 Total Male 0.9 2.5 5.4 8.3 9.0 6.8 5.1 38 Female 1.5 4.0 8.8 13.7 14.7 10.9 8.4 62 TABLE 41 Starting distribution of HAQ scores Moves dependent on toxicity Treatment Always move to Relevant toxicity If toxic, move to Otherwise, move to MTX MTX SSZ MTX+SSZ SSZ Adal MTX+SSZ Adal Adal Etan Etan Divergence point Option 1 Infl+MTX Infl+MTX LEF Option 2 LEF LEF GST GST AZA AZA CyA CyA CyA or MTX DPen CyA+MTX CyA+MTX DPen DPen Pall HAQ 0.125 0.25 0.375 0.5 0.625 0.75 0.875 % 3.1 6.7 6.7 5.8 5.3 4.9 4.8 HAQ 1 1.125 1.25 1.375 1.5 1.625 1.75 % 4.9 5.1 5.5 5.8 6.3 6.6 7.0 HAQ 1.875 2 2.125 2.25 2.375 2.5 Higher % 6.9 6.2 4.7 2.7 0.9 0.1 0 93
Page 1 and 2:
A systematic review of the effectiv
Page 3 and 4:
A systematic review of the effectiv
Page 5 and 6:
Objectives: This report reviews the
Page 7:
Glossary and list of abbreviations
Page 10 and 11:
viii Glossary and list of abbreviat
Page 13 and 14:
Background Rheumatoid arthritis (RA
Page 15:
increased risk of serious infection
Page 19 and 20:
Summary RA is a common, chronic, in
Page 21 and 22:
(IL-2) and interleukin-6 (IL-6), pr
Page 23 and 24:
Assessment of response to DMARDs Re
Page 25 and 26:
combination with methotrexate or al
Page 27:
disease between clinic appointments
Page 30 and 31:
14 Effectiveness in juvenile arthri
Page 32 and 33:
16 Effectiveness adalimumab plus me
Page 34 and 35:
18 Effectiveness Monoclonal Antibod
Page 36 and 37:
20 TABLE 1 Description of included
Page 38 and 39:
22 TABLE 2 Quality of included RCTs
Page 40 and 41:
24 Effectiveness change in modified
Page 42 and 43:
26 Effectiveness TABLE 4 Meta-analy
Page 44 and 45:
28 Effectiveness Review: Adalimumab
Page 46 and 47:
30 Effectiveness Review: Adalimumab
Page 48 and 49:
32 TABLE 6 Effectiveness Descriptio
Page 50 and 51:
34 TABLE 6 Effectiveness Descriptio
Page 52 and 53:
36 TABLE 7 Effectiveness Quality of
Page 54 and 55:
38 Effectiveness etanercept trials.
Page 56 and 57:
40 Effectiveness TABLE 9 Summary of
Page 58 and 59: 42 Effectiveness Review: Etanercept
Page 70 and 71: 54 Effectiveness TABLE 11 Summary o
Page 72 and 73: 56 TABLE 12 Description of included
Page 74 and 75: 58 TABLE 13 Quality of included RCT
Page 76 and 77: 60 Effectiveness per week and escal
Page 78 and 79: 62 Effectiveness significant advant
Page 80 and 81: 64 Effectiveness Review: Infliximab
Page 82 and 83: 66 Effectiveness Review: Infliximab
Page 84 and 85: 68 Effectiveness FIGURE 44 Malignan
Page 86 and 87: 70 TABLE 17 Effectiveness Summary o
Page 89 and 90: Summary of review of existing econo
Page 91 and 92: TABLE 20 Summary of published ICERs
Page 93 and 94: TABLE 21 Published etanercept econo
Page 95 and 96: TABLE 23 Published economic analyse
Page 97 and 98: TABLE 25 Treatment sequences: adali
Page 99 and 100: management of RA, i.e. 1st and 2nd
Page 101 and 102: To estimate the long-term consequen
Page 103 and 104: TABLE 32 TNF inhibitors as last act
Page 105 and 106: TABLE 34 Basic structure of the mod
Page 107: een quit on grounds of toxicity, ad
Page 111 and 112: TABLE 43 Beta distributions for HAQ
Page 113 and 114: TABLE 44 Early cessation of DMARDs:
Page 115 and 116: TABLE 46 Unit costs for tests and v
Page 117 and 118: following properties, according to
Page 119 and 120: TABLE 52 Base case: TNF inhibitors
Page 121 and 122: TABLE 54 Base case: TNF inhibitors
Page 123 and 124: TABLE 59 Third TNF inhibitor follow
Page 125 and 126: TABLE 65 Sensitivity analyses: TNF
Page 127 and 128: TABLE 67 Sensitivity analyses: TNF
Page 129: The substantial economic impact of
Page 133 and 134: Summary Effectiveness: principal fi
Page 135 and 136: inhibitors, although the incrementa
Page 137 and 138: introduce bias which generally exag
Page 139: Adalimumab, etanercept and inflixim
Page 143 and 144: 1. Jobanputra P, Barton P, Bryan S,
Page 145 and 146: 46. Young A, Dixey J, Cox N, Davies
Page 147 and 148: tumor necrosis factor therapy in th
Page 149 and 150: arthritis: a 12-week, double-blind,
Page 151 and 152: 171. Geborek P, Crnkic M, Petersson
Page 153 and 154: 216. Schotte H, Willeke P, Mickholz
Page 155 and 156: The Health Assessment Questionnaire
Page 157 and 158: Cochrane Library (CENTRAL) 2005 Iss
Page 159 and 160:
Appendix 3 © Queen’s Printer and
Page 161:
TABLE 69 Studies excluded from clin
Page 164 and 165:
148 Appendix 4 TABLE 71 Meta-analys
Page 166 and 167:
150 Appendix 4 TABLE 73 Meta-analys
Page 168 and 169:
152 Appendix 4 Infliximab versus pl
Page 170 and 171:
154 Appendix 4 Infliximab plus MTX
Page 173:
Ovid MEDLINE(R) 1966 to February we
Page 177 and 178:
Appendix 8 © Queen’s Printer and
Page 179 and 180:
TABLE 79 Wong et al., 2002 161 © Q
Page 181 and 182:
TABLE 80 Kobelt et al., 2003 162 (c
Page 183 and 184:
TABLE 82 Brennan et al., 2004 160
Page 185 and 186:
Page 187 and 188:
TABLE 85 Bansback et al., 2005 166
Page 189:
Page 192 and 193:
176 Appendix 9 TABLE 89 Strategy se
Page 195 and 196:
Extensive sensitivity analysis was
Page 197 and 198:
TABLE 96 Variation 1: TNF inhibitor
Page 199 and 200:
TABLE 99 Variation 2: TNF inhibitor
Page 201 and 202:
TABLE 102 Variation 3: TNF inhibito
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Page 219 and 220:
Page 221 and 222:
TABLE 132 Variation 10: TNF inhibit
Page 223 and 224:
Page 225 and 226:
Page 227 and 228:
Page 229 and 230:
Page 231 and 232:
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243:
Page 247 and 248:
Volume 1, 1997 No. 1 Home parentera
Page 249 and 250:
No. 3 Screening for sickle cell dis
Page 251 and 252:
No. 25 A rapid and systematic revie
Page 253 and 254:
No. 11 First and second trimester a
Page 255 and 256:
No. 23 Clinical effectiveness and c
Page 257 and 258:
No. 28 Outcomes of electrically sti
Page 259:
No. 28 Adefovir dipivoxil and pegyl
Page 262 and 263:
246 Health Technology Assessment Pr
Page 264:
248 Health Technology Assessment Pr
show all

A systematic review of the effectiveness of adalimumab

Create successful ePaper yourself

Delete template?

Save as template?