A systematic review of the effectiveness of adalimumab

TABLE 83 Kobelt et al., 2004 163 (cont’d)
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Health Technology Assessment 2006; Vol. 10: No. 42
Sensitivity analysis Sensitivity analysis was undertaken on all 160 patients: all patients who began one of the
treatments. The main economic evaluation was based on those patients who continued to
receive TNF inhibitor treatment for at least 12 months and had complete data (116 patients)
Modelling inputs and NA
techniques appropriate
Authors’ conclusions Cost-effectiveness ratios are within the generally accepted threshold of €50,000, but need
to be confirmed with larger samples. Assuming that the improvements occurred within
3 months after treatment, the cost per QALY is €36,900. Sensitivity analysis, including all
160 patients, gave an estimated cost per QALY of €53,600. The cost per QALY increases for
patient groups with less severe disease
TABLE 84 Chiou et al., 2004 170
Authors Chiou, Choi, Reyes
Date 2004
Type of economic evaluation Cost–utility analysis
Country of origin USA
Currency used US dollars
Year to which costs apply 2003
Perspective Healthcare (payers)
Study population Patients with moderate to severe RA who were deemed candidates for the following
biological monotherapies and combination therapies
Intervention 1 Adalimumab
Intervention 2 Anakinra (reference case for monotherapy)
Intervention 3 Etanercept
Intervention 4 Adalimumab + MTX
Intervention 5 Anakinra + MTX
Intervention 6 Etanercept + MTX
Intervention 7 Infliximab + MTX
Source of effectiveness data Effectiveness data were sourced from a review of previously published RCTs. The results of
the review were presented to an expert panel of rheumatologists who selected the relevant
clinical trials based on similar patient inclusion criteria and baseline characteristics. ACR
response criteria: ACR20, ACR50 and ACR70 were used in the model. Probabilities for
achieving ACR20, ACR50 and ACR70 for each treatment strategy were sourced from
published literature. The absolute response rates from the clinical trial data with the most
comparable patient population characteristics and study design were used as input data for
the model. SAE rates were also sourced from clinical trial data. The same expert panel
classified the adverse events, associated with each treatment strategy, into severity levels and
estimated the corresponding medical resource use associated with each. SAEs were
categorised as mild, moderate or severe. The highest frequency reported in a study was
used to assign the probability within each severity classification. Probabilities for being in each
health state were determined by the product of the probability of achieving each ACR
response criterion and for developing different levels of SAEs, assuming that the probabilities
for achieving each were independent
Cost data handled Yes. Drug costs were based on US average wholesale prices. Healthcare resource costs for
appropriately medication, injection and infusion, monitoring and management of SAEs were obtained from
the 2003 American Medical Association Current Procedural Terminology (CPT codes)
codebook, the 2003 Medicare Reimbursement Fee Schedule and the Medstat Diagnosis
Related Group (DRG) Guide. The costs of complications were estimated as follows: a mild
complication included the cost of one visit every 6 months and associated laboratory tests,
the cost of a moderate complication included that of a mild complication plus the cost of
antibiotics, and the cost of a severe complication included the cost of hospitalisation for
pneumonia or sepsis
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