A systematic review of the effectiveness of adalimumab

More documents

Recommendations

Info

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
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 60 and 61:
Page 62 and 63:
Page 64 and 65:
Page 66 and 67:
Page 68 and 69:
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 and 108:
een quit on grounds of toxicity, ad
Page 109 and 110:
TABLE 39 Strategy set: adalimumab a
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: Appendix 8 © Queen’s Printer and
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: TABLE 83 Kobelt et al., 2004 163 (c
Page 187 and 188: TABLE 85 Bansback et al., 2005 166
Page 189: TABLE 86 Kobelt et al., 2005 167 (c
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 221 and 222: TABLE 132 Variation 10: TNF inhibit
Page 229 and 230:
TABLE 144 Variation 13: TNF inhibit
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?