A systematic review of the effectiveness of adalimumab

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162 Appendix 8 TABLE 78 Choi et al., 2002 159 (cont’d) Outcome measures used in The occurrence of toxicity related to each therapy and ACR response criteria (ACR20 or economic evaluations ACR70). ICERs were for per patient achieving ACR20 or ACR70WR Direction of result with In the base-case analysis using either ACR20 or ACR70WR for MTX-naïve RA, MTX and SSZ appropriate quadrant both cost less and were more effective (SE quadrant: cost saving) than no second-line location therapy. SSZ compared with MTX at ACR20 was in the NE quadrant (more costly but also more effective). Using ACR70, SSZ compared with MTX cost more but was less effective (NW quadrant). LEF was also ruled out by simple dominance when compared with MTX (i.e. NW quadrant). Compared with MTX and SSZ, etanercept was both more expensive and more effective (i.e. NE quadrant): etanercept vs SSZ: $41,900 per ACR20 etanercept vs MTX: $40,800 per ACR70WR Statistical analysis for Not undertaken patient-level stochastic data Appropriateness of statistical NA analysis Uncertainty around Not undertaken cost-effectiveness expressed Appropriateness of method NA dealing with uncertainty around cost effectiveness Sensitivity analysis Yes: sensitivity analyses were performed to determine the robustness of the base-case results to variations of baseline estimates. Three-way sensitivity analyses were also done to determine robustness of base-case results to variations of more than one key variable, including the main variable of triple therapy efficacy Modelling inputs and Yes techniques appropriate Authors’ conclusions MTX is cost-effective (cost savings vs the no second-line treatment option) for MTX-naïve RA in achieving ACR20 or ACR70WR over a 6-month period. The relative cost-effectiveness between SSZ and MTX cannot be determined with reasonable certainty, but SSZ therapy appears to be as cost-effective as MTX (cost saving) in achieving ACR outcomes over a 6-month period. The most efficacious option, etanercept, incurs higher incremental costs per ACR20 or ACR70WR than other options analysed. Whether etanercept compared with MTX is cost-effective depends on whether >$40,000 per ACR20 or ACR70WR over a 6-month period is considered acceptable NE, north-east; NW, north-west; SE, south-east.
TABLE 79 Wong et al., 2002 161 © Queen’s Printer and Controller of HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 Authors Wong, Singh, Kavanaugh Date 2002 Type of economic evaluation Cost–utility analysis Country of origin USA Currency used US dollars Year to which costs apply 1998 Perspective Societal Study population Patients with active, refractory RA Intervention 1 Placebo + MTX Intervention 2 Infliximab + MTX Source of effectiveness data Data were extrapolated from ATTRACT and ARAMIS. Quality of life data were assessed as self-reported global health using a VAS: for the first year data from ATTRACT were used and after the first year estimates were based on ARAMIS Cost data handled Yes. Drug costs were based on the average wholesale price of infliximab, infusion appropriately administration costs and pretreatment evaluation. Direct costs were taken from ATTRACT and included all non-protocol-related medical care costs. For a societal perspective, indirect cost estimates from ATTRACT were also used for the first year for the subset of patients who were employed at the time of enrolment. Indirect costs beyond the first year were estimated to be between one and three times the costs in year 1. Costs from ARAMIS included self-reported hospitalisation, emergency room visits, outpatient surgeries, home care and non-traditional treatments, as well as those for physicians, therapists and nurse practitioners, laboratory tests, radiological studies, drugs and nursing home, rehabilitation or hospitalisation Modelling summary Markov model consisting of 21 health states to project the 54-week results of RCTs to lifetime economic and clinical outcomes. A cycle length of 6 months was used Outcome measures used in Life expectancy and QALYs (based on VAS) to calculate cost per QALY economic evaluations Direction of result with NE quadrant. $30,500 per QALY appropriate quadrant location Statistical analysis for Not undertaken patient-level stochastic data Appropriateness of statistical NA analysis Uncertainty around Not undertaken cost-effectiveness expressed Appropriateness of method NA dealing with uncertainty around cost effectiveness Sensitivity analysis Yes. Sensitivity analyses were conducted to examine the impact of varying the values used, with and without indirect costs related to productivity losses from disability Modelling inputs and Yes techniques appropriate Authors’ conclusions Infliximab plus MTX for 54 weeks for RA should be cost-effective, with its clinical benefit providing good value for the drug cost, especially when including productivity losses. Although infliximab beyond 54 weeks will be likely to be cost-effective, the economics and clinical benefit remain uncertain and will depend on long-term results of clinical trials 163
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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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Page 139: Adalimumab, etanercept and inflixim
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A systematic review of the effectiveness of adalimumab

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