A systematic review of the effectiveness of adalimumab

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94 Health economics TABLE 42 Fitting beta distribution to HAQ change data for leflunomide square, the larger the number of simulated patients with that pair of HAQ values. It can be seen that there is a high proportion of patients with equal HAQ on treatment compared with before treatment. In this example, the sampled population contains a large number of zero initial HAQ values. These are omitted from the graphs, but included in the calculations relating to HAQ improvement. Table 43 shows the parameters found for the beta distributions. Two sets of figures are given for each of the TNF inhibitors: one for early RA HAQ on treatment 3 2 1 0 Mean SD Initial HAQ parameters 1.01 0.66 Initial HAQ sampled 1.03 0.62 HAQ improvement 0.48 0.50 a b Beta parameters 0.57 0.65 and one for late RA. The columns headed a and b are the actual parameters of the distribution, while the column headed Mean gives the mean value of the distribution. Since the distribution is for a multiplier giving HAQ improvement, the higher the mean, the more effective the treatment. Consider, for example, a patient with HAQ before treatment equal to 2.5. The effect of a treatment with mean 0.6 will lie somewhere between two extremes. One extreme is that all patients have HAQ reduced by 0.6 × 2.5 = 1.5, so that HAQ on treatment would be 1.0, while the other extreme is that 60% of patients have HAQ reduced to zero, while the other 40% have no change in HAQ. Where values of a and b are both less than 1, as is generally the case for the values used here, the distribution is close to the second of these cases. Time on treatments The model allows for two stages of early quitting of treatment. Figure 48 shows the general shape for the survival curve assumed for a particular treatment. The first step represents cessation of treatment after 6 weeks, which is assumed to be 0 1 2 3 HAQ before treatment FIGURE 47 Modelled distribution of HAQ change on starting leflunomide
TABLE 43 Beta distributions for HAQ multipliers Treatment a b Mean Source © Queen’s Printer and Controller of HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 Adal early RA [Commercial- [Commercial- [Commercial- From PREMIER trial 102 (DE013); unpublished in-confidence in-confidence in-confidence data (observed values) from trial report. information information information MTX-naïve patients removed] removed] removed] Adal late RA 0.16 0.61 0.21 From van de Putte 113 (DE011), data with LOCF imputation, without concomitant MTX Adal + MTX [Commercial- [Commercial- [Commercial- From PREMIER trial 102 (DE013); unpublished early RA in-confidence in-confidence in-confidence data (observed values) from trial report. information information information MTX-naïve patients. removed] removed] removed] Adal + MTX 1.08 1.36 0.44 Combined results from ARMADA trial 112 late RA (DE009) and Keystone 114 (DE019) AZA 0.20 0.80 0.20 Data assumed to be similar to anakinra using data from Bresnihan 174 CyA 0.13 0.26 0.33 RCT of GST vs CyA in early RA, 175 Kvien 176 Etan early RA 0.59 0.52 0.53 From ERA trial. 123 Unpublished data with LOCF imputation from trial report. MTX-naïve patients Etan late RA 0.43 0.67 0.39 Combined results from Moreland, 122 Codreanu103 and TEMPO. 127 Unpublished data with LOCF imputation from trial reports Etan + MTX 0.72 0.50 0.59 From TEMPO 127 (data from Wyeth submission) early RA Etan + MTX 0.20 0.30 0.40 From Weinblatt. 125 Unpublished data with late RA LOCF imputation from trial report GST 0.45 0.70 0.39 As for CyA HCQ 0.15 0.40 0.27 Trial of HCQ in early RA 177 Infl (+MTX) 0.76 0.67 0.53 From St Clair 135 (ASPIRE trial). MTX-naïve early RA patients Infl (+MTX) 0.11 0.38 0.22 From ATTRACT 132 (unpublished data from late RA trial report, observed values) LEF 0.57 0.65 0.47 RCT of LEF vs MTX 173 MTX 0.98 0.82 0.54 As for LEF DPen 0.20 0.80 0.20 Assumed same as AZA SSZ 0.70 0.84 0.45 Follow-up observations of patients involved in an RCT, 178 Smolen 179 Combination 0.80 0.45 0.64 Data from an RCT of CyA vs CyA combined CyA + MTX with MTX in early RA 180 Combination 0.70 0.84 0.45 Assumed as for SSZ MTX+SSZ Combination 0.15 0.40 0.27 Assumed as for HCQ MTX+SSZ+HCQ LOCF, last observation carried forward. 95
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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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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
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Page 109: TABLE 39 Strategy set: adalimumab a
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
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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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176 Appendix 9 TABLE 89 Strategy se
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Extensive sensitivity analysis was
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TABLE 96 Variation 1: TNF inhibitor
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TABLE 99 Variation 2: TNF inhibitor
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TABLE 102 Variation 3: TNF inhibito
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TABLE 132 Variation 10: TNF inhibit
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Volume 1, 1997 No. 1 Home parentera
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No. 3 Screening for sickle cell dis
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No. 25 A rapid and systematic revie
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246 Health Technology Assessment Pr
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