A systematic review of the effectiveness of adalimumab

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180 Appendix 10 TABLE 95 Variation 1: TNF inhibitors third (early RA values) (20,000 patients) Option Cost (£) QSE QALYs QSE Adal 48,371 221 6.8542 0.0366 Etan 61,650 271 7.7651 0.0413 Adal+MTX 48,830 224 7.0461 0.0368 Etan+MTX 61,349 270 7.8660 0.0416 Infl+MTX 48,298 212 6.9820 0.0365 Base 16,444 51 5.3484 0.0306 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 31,926 217 1.5058 0.0352 Etan – Base 45,206 263 2.4167 0.0390 Ad+M – Base 32,386 220 1.6977 0.0353 Et+M – Base 44,905 262 2.5176 0.0397 In+M – Base 31,854 208 1.6336 0.0352 Ad+M – Adal 459 295 0.1919 0.0380 Etan – Et+M 301 351 –0.1009 0.0440 Etan – Adal 13,280 326 0.9109 0.0411 Et+M – Ad+M 12,519 327 0.8199 0.0418 In+M – Ad+M 532 289 0.0641 0.0383 Et+M – In+M 13,051 321 0.8840 0.0415 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 21,200 20,200 to 22,300 Etan – Base 18,700 18,100 to 19,400 Ad+M – Base 19,100 18,300 to 19,900 Et+M – Base 17,800 17,300 to 18,500 In+M – Base 19,500 18,700 to 20,400 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Etan – Et+M Etan+MTX more effective than Etan alone; diff. cost not significant Etan – Adal 14,600 13,200 to 16,200 Et+M – Ad+M 15,300 13,700 to 17,200 In+M – Ad+M Comparison is inconclusive Et+M – In+M 14,800 13,300 to 16,500 TABLE 96 Variation 1: TNF inhibitors third (late RA values) (40,000 patients) Option Cost (£) QSE QALYs QSE Adal 47,664 156 6.1760 0.0254 Etan 60,598 191 7.2320 0.0286 Adal+MTX 48,194 157 6.4741 0.0253 Etan+MTX 60,894 191 7.2297 0.0289 Infl+MTX 47,561 149 6.2132 0.0254 Base 16,490 36 5.4254 0.0218 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 31,174 152 0.7506 0.0234 Etan – Base 44,107 185 1.8066 0.0264 Ad+M – Base 31,704 153 1.0487 0.0238 Et+M – Base 44,404 186 1.8043 0.0268 In+M – Base 31,071 145 0.7878 0.0237 Ad+M – Adal 530 206 0.2981 0.0245 Et+M – Etan 296 247 0.0023 0.0293 Etan – Adal 12,934 228 1.0560 0.0269 Et+M – Ad+M 12,700 230 0.7556 0.0276 Ad+M – In+M 633 202 0.2609 0.0248 Et+M – In+M 13,333 224 1.0165 0.0273 continued
TABLE 96 Variation 1: TNF inhibitors third (late RA values) (40,000 patients) (cont’d) © Queen’s Printer and Controller <strong>of</strong> HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 41,500 39,100 to 44,300 Etan – Base 24,400 23,700 to 25,200 Ad+M – Base 30,200 28,900 to 31,700 Et+M – Base 24,600 23,900 to 25,400 In+M – Base 39,400 37,200 to 42,000 Ad+M – Adal 1,780 362 to 3,190 Et+M – Etan Comparison is inconclusive Etan – Adal 12,200 11,500 to 13,100 Et+M – Ad+M 16,800 15,500 to 18,300 Ad+M – In+M 2,420 811 to 4,040 Et+M – In+M 13,100 12,300 to 14,000 TABLE 97 Variation 1: TNF inhibitors last (20,000 patients) Option Cost (£) QSE QALYs QSE Adal 36,801 219 2.3062 0.0253 Etan 49,842 267 3.6405 0.0320 Adal+MTX 37,043 221 2.5987 0.0259 Etan+MTX 49,381 267 3.6409 0.0323 Infl+MTX 36,517 211 2.3587 0.0258 Base 2,848 11 1.0512 0.0185 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 33,954 217 1.2550 0.0188 Etan – Base 46,994 264 2.5893 0.0276 Ad+M – Base 34,195 219 1.5475 0.0202 Et+M – Base 46,533 264 2.5897 0.0282 In+M – Base 33,670 209 1.3076 0.0198 Ad+M – Adal 242 301 0.2925 0.0246 Etan – Et+M 461 353 –0.0004 0.0361 Etan – Adal 13,041 330 1.3343 0.0305 Et+M – Ad+M 12,338 331 1.0422 0.0321 Ad+M – In+M 526 294 0.2400 0.0253 Et+M – In+M 12,863 323 1.2821 0.0315 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 27,100 26,200 to 28,000 Etan – Base 18,100 17,700 to 18,600 Ad+M – Base 22,100 21,500 to 22,800 Et+M – Base 18,000 17,500 to 18,400 In+M – Base 25,700 24,900 to 26,600 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 9,770 9,110 to 10,400 Et+M – Ad+M 11,800 10,900 to 12,900 Ad+M – In+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 10,000 9,330 to 10,700 181
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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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TABLE 67 Sensitivity analyses: TNF
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The substantial economic impact of
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Summary Effectiveness: principal fi
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inhibitors, although the incrementa
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introduce bias which generally exag
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Adalimumab, etanercept and inflixim
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1. Jobanputra P, Barton P, Bryan S,
Page 145 and 146: 46. Young A, Dixey J, Cox N, Davies
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Page 155 and 156: The Health Assessment Questionnaire
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Page 170 and 171: 154 Appendix 4 Infliximab plus MTX
Page 173: Ovid MEDLINE(R) 1966 to February we
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Page 181 and 182: TABLE 80 Kobelt et al., 2003 162 (c
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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
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Page 195: Extensive sensitivity analysis was
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Page 221 and 222: 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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No. 28 Outcomes of electrically sti
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No. 28 Adefovir dipivoxil and pegyl
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246 Health Technology Assessment Pr
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A systematic review of the effectiveness of adalimumab

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