A systematic review of the effectiveness of adalimumab

Extensive sensitivity analysis was carried out for
all strategy sets involving the use of a single
TNF inhibitor. As in the base case, for the HAQ
improvement on starting a TNF inhibitor, the
early RA values were used for the strategy set
involving TNF inhibitors at the start, the late RA
values were used for TNF inhibitors last, and both
sets of values were used for TNF inhibitors in
third place.
There is a total of 18 variations on the original
parameter set. These are described in detail at the
start of each set of results. In each case, all
parameters not mentioned in the description of
TABLE 94 Variation 1: TNF inhibitors first (100,000 patients)
Appendix 10
Sensitivity analysis
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Health Technology Assessment 2006; Vol. 10: No. 42
the variation were assumed to take their base-case
values.
Variation 1
For this variation, it was assumed that there was no
progression in HAQ score while on TNF
inhibitors, and progression was as for the base case
on other treatments.
Option Cost (£) QSE QALYs QSE
Adal 49,558 103 9.5740 0.0182
Etan 64,270 125 10.3899 0.0201
Adal+MTX 49,912 104 9.2247 0.0177
Etan+MTX 64,499 126 10.0596 0.0200
Infl+MTX 49,188 99 9.0404 0.0177
Base 15,322 21 8.3056 0.0158
Comparison Diff. cost (£) QSE Diff. QALY QSE
Adal – Base 34,236 101 1.2685 0.0177
Etan – Base 48,948 122 2.0844 0.0191
Ad+M – Base 34,590 103 0.9191 0.0177
Et+M – Base 49,177 124 1.7541 0.0192
In+M – Base 33,866 97 0.7348 0.0175
Ad+M – Adal 354 141 –0.3493 0.0187
Et+M – Etan 229 167 –0.3303 0.0210
Etan – Adal 14,712 154 0.8159 0.0198
Et+M – Ad+M 14,587 156 0.8349 0.0200
Ad+M – In+M 724 138 0.1844 0.0185
Et+M – In+M 15,311 153 1.0193 0.0199
Comparison ICER (£ per QALY) Quasi-CI
Adal – Base 27,000 26,200 to 27,800
Etan – Base 23,500 23,000 to 23,900
Ad+M – Base 37,600 36,200 to 39,200
Et+M – Base 28,000 27,400 to 28,700
In+M – Base 46,100 44,000 to 48,400
Ad+M – Adal Adal alone dominates Adal+MTX
Et+M – Etan Etan alone more effective than Etan+MTX; diff. cost not significant
Etan – Adal 18,000 17,100 to 19,000
Et+M – Ad+M 17,500 16,600 to 18,400
Ad+M – In+M 3,930 2,230 to 5,620
Et+M – In+M 15,000 14,400 to 15,700
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