A systematic review of the effectiveness of adalimumab

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186 Appendix 10 TABLE 104 Variation 3: TNF inhibitors third (late RA values) (200,000 patients) Option Cost (£) QSE QALYs QSE Adal 47,618 69 6.4691 0.0115 Etan 60,491 84 7.0178 0.0117 Adal+MTX 48,013 69 6.7402 0.0114 Etan+MTX 60,620 84 7.0029 0.0119 Infl+MTX 47,539 66 6.5037 0.0115 Base 16,572 16 6.5310 0.0111 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 31,046 67 –0.0620 0.0105 Etan – Base 43,919 81 0.4868 0.0109 Ad+M – Base 31,441 68 0.2092 0.0106 Et+M – Base 44,048 82 0.4719 0.0111 In+M – Base 30,966 65 –0.0274 0.0105 Ad+M – Adal 394 91 0.2712 0.0106 Et+M – Etan 130 109 –0.0148 0.0115 Etan – Adal 12,872 100 0.5487 0.0110 Et+M – Ad+M 12,608 101 0.2627 0.0111 Ad+M – In+M 474 90 0.2366 0.0106 Et+M – In+M 13,082 99 0.4993 0.0112 Comparison ICER (£ per QALY) Quasi-CI Adal – Base Base dominates Adal Etan – Base 90,200 86,300 to 94,500 Ad+M – Base 150,000 137,000 to 167,000 Et+M – Base 93,300 89,100 to 97,900 In+M – Base Base dominates Infl+MTX Ad+M – Adal 1,450 770 to 2,140 Et+M – Etan Comparison is inconclusive Etan – Adal 23,500 22,500 to 24,500 Et+M – Ad+M 48,000 44,200 to 52,500 Ad+M – In+M 2,000 1,230 to 2,780 Et+M – In+M 26,200 25,000 to 27,500 TABLE 105 Variation 3: TNF inhibitors last (20,000 patients) Option Cost (£) QSE QALYs QSE Adal 36,505 217 3.0616 0.0268 Etan 49,138 263 3.9234 0.0289 Adal+MTX 36,861 219 3.3262 0.0268 Etan+MTX 48,704 263 3.8854 0.0295 Infl+MTX 36,554 210 3.0937 0.0273 Base 2,913 12 2.5375 0.0256 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 33,591 214 0.5241 0.0188 Etan – Base 46,224 260 1.3859 0.0237 Ad+M – Base 33,947 217 0.7887 0.0196 Et+M – Base 45,790 260 1.3479 0.0238 In+M – Base 33,640 208 0.5562 0.0192 Ad+M – Adal 356 297 0.2646 0.0216 Etan – Et+M 434 348 0.0380 0.0290 Etan – Adal 12,633 323 0.8618 0.0255 Et+M – Ad+M 11,843 326 0.5592 0.0260 In+M – Ad+M 307 292 0.2325 0.0222 Et+M – In+M 12,150 319 0.7917 0.0260 continued
TABLE 105 Variation 3: TNF inhibitors last (20,000 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 64,100 59,700 to 69,100 Etan – Base 33,400 32,200 to 34,600 Ad+M – Base 43,000 40,900 to 45,400 Et+M – Base 34,000 32,800 to 35,300 In+M – Base 60,500 56,500 to 65,000 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Etan – Et+M Comparison is inconclusive Etan – Adal 14,700 13,600 to 15,900 Et+M – Ad+M 21,200 19,100 to 23,700 In+M – Ad+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 15,300 14,200 to 16,800 Variation 4 For this variation, it was assumed that HAQ progression on all treatments was at 0.06 per year. TABLE 106 Variation 4: TNF inhibitors first (1,000,000 patients) Option Cost (£) QSE QALYs QSE Adal 49,224 32 7.7643 0.0046 Etan 63,281 39 7.8800 0.0047 Adal+MTX 49,404 32 7.3785 0.0044 Etan+MTX 63,465 39 7.5377 0.0045 Infl+MTX 48,751 31 7.2236 0.0044 Base 15,234 7 7.3969 0.0044 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 33,990 31 0.3674 0.0049 Etan – Base 48,047 38 0.4830 0.0050 Ad+M – Base 34,170 32 –0.0185 0.0048 Et+M – Base 48,231 38 0.1408 0.0049 In+M – Base 33,517 30 –0.1733 0.0048 Ad+M – Adal 180 44 –0.3858 0.0049 Et+M – Etan 184 51 –0.3423 0.0050 Etan – Adal 14,057 47 0.1157 0.0050 Et+M – Ad+M 14,061 48 0.1592 0.0048 In+M – Ad+M 653 43 0.1548 0.0047 Et+M – In+M 14,714 47 0.3141 0.0048 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 92,500 90,100 to 95,100 Etan – Base 99,500 97,500 to 102,000 Ad+M – Base Base dominates Adal+MTX Et+M – Base 343,000 320,000 to 368,000 In+M – Base Base dominates Infl+MTX Ad+M – Adal Adal alone dominates Adal+MTX Et+M – Etan Etan alone dominates Etan+MTX Etan – Adal 122,000 112,000 to 133,000 Et+M – Ad+M 88,300 83,200 to 94,000 In+M – Ad+M 4,220 3,610 to 4,830 Et+M – In+M 46,900 45,400 to 48,400 187
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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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arthritis: a 12-week, double-blind,
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A systematic review of the effectiveness of adalimumab

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