A systematic review of the effectiveness of adalimumab

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184 Appendix 10 TABLE 101 Variation 2: TNF inhibitors last (40,000 patients) Option Cost (£) QSE QALYs QSE Adal 36,137 151 2.5122 0.0164 Etan 49,203 186 3.5657 0.0193 Adal+MTX 36,712 154 2.7769 0.0166 Etan+MTX 49,570 187 3.5483 0.0196 Infl+MTX 36,295 147 2.5568 0.0167 Base 2,866 8 1.6689 0.0141 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 33,271 150 0.8433 0.0120 Etan – Base 46,337 184 1.8969 0.0163 Ad+M – Base 33,846 152 1.1080 0.0128 Et+M – Base 46,704 185 1.8794 0.0166 In+M – Base 33,429 145 0.8879 0.0125 Ad+M – Adal 575 208 0.2647 0.0148 Et+M – Etan 366 247 –0.0175 0.0209 Etan – Adal 13,066 228 1.0535 0.0179 Et+M – Ad+M 12,857 229 0.7714 0.0185 Ad+M – In+M 417 205 0.2201 0.0153 Et+M – In+M 13,275 226 0.9915 0.0185 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 39,500 38,300 to 40,700 Etan – Base 24,400 24,000 to 24,900 Ad+M – Base 30,500 29,800 to 31,300 Et+M – Base 24,900 24,400 to 25,300 In+M – Base 37,600 36,600 to 38,800 Ad+M – Adal 2,170 583 to 3,760 Et+M – Etan Comparison is inconclusive Etan – Adal 12,400 11,800 to 13,000 Et+M – Ad+M 16,700 15,700 to 17,700 Ad+M – In+M 1,900 11 to 3,780 Et+M – In+M 13,400 12,700 to 14,100 Variation 3 For this variation, it was assumed that HAQ progression on all treatments (including palliation) was at 0.03 per year. TABLE 102 Variation 3: TNF inhibitors first (200,000 patients) Option Cost (£) QSE QALYs QSE Adal 49,569 72 9.7112 0.0131 Etan 63,858 87 9.8759 0.0133 Adal+MTX 49,774 73 9.2703 0.0124 Etan+MTX 64,028 88 9.5070 0.0128 Infl+MTX 49,024 69 9.1106 0.0125 Base 15,432 15 9.4317 0.0127 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 34,137 71 0.2796 0.0127 Etan – Base 48,426 85 0.4442 0.0129 Ad+M – Base 34,342 72 –0.1614 0.0124 Et+M – Base 48,596 86 0.0754 0.0127 In+M – Base 33,592 68 –0.3210 0.0124 Ad+M – Adal 205 98 –0.4410 0.0125 continued
TABLE 102 Variation 3: TNF inhibitors first (200,000 patients) (cont’d) © Queen’s Printer and Controller <strong>of</strong> HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 Et+M – Etan 170 116 –0.3689 0.0130 Etan – Adal 14,288 107 0.1647 0.0130 Et+M – Ad+M 14,254 109 0.2368 0.0124 Ad+M – In+M 750 97 0.1596 0.0121 Et+M – In+M 15,004 107 0.3964 0.0124 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 122,000 112,000 to 134,000 Etan – Base 109,000 103,000 to 116,000 Ad+M – Base Base dominates Adal+MTX Et+M – Base 645,000 483,000 to 971,000 In+M – Base Base dominates Infl+MTX Ad+M – Adal Adal alone dominates Adal+MTX Et+M – Etan Etan alone more effective than Etan+MTX; diff. cost not significant Etan – Adal 86,800 74,900 to 103,000 Et+M – Ad+M 60,200 54,400 to 67,300 Ad+M – In+M 4,700 3,290 to 6,110 Et+M – In+M 37,900 35,600 to 40,500 TABLE 103 Variation 3: TNF inhibitors third (early RA values) (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 48,353 98 7.1282 0.0162 Etan 61,090 119 7.5230 0.0169 Adal+MTX 48,521 98 7.2854 0.0163 Etan+MTX 61,314 119 7.6104 0.0169 Infl+MTX 48,159 94 7.2431 0.0162 Base 16,597 23 6.5465 0.0157 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 31,756 96 0.5816 0.0153 Etan – Base 44,493 115 0.9765 0.0160 Ad+M – Base 31,924 96 0.7389 0.0153 Et+M – Base 44,717 116 1.0639 0.0160 In+M – Base 31,562 92 0.6966 0.0153 Ad+M – Adal 169 131 0.1573 0.0157 Et+M – Etan 224 155 0.0874 0.0169 Etan – Adal 12,737 144 0.3948 0.0164 Et+M – Ad+M 12,792 144 0.3250 0.0163 Ad+M – In+M 363 128 0.0423 0.0157 Et+M – In+M 13,155 141 0.3673 0.0163 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 54,600 51,900 to 57,700 Etan – Base 45,600 44,100 to 47,100 Ad+M – Base 43,200 41,500 to 45,100 Et+M – Base 42,000 40,800 to 43,400 In+M – Base 45,300 43,400 to 47,400 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Etan+MTX more effective than Etan alone; diff. cost not significant Etan – Adal 32,300 29,700 to 35,300 Et+M – Ad+M 39,400 35,700 to 43,900 Ad+M – In+M 8,570 Not determined Et+M – In+M 35,800 32,800 to 39,400 185
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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,
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46. Young A, Dixey J, Cox N, Davies
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tumor necrosis factor therapy in th
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A systematic review of the effectiveness of adalimumab

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