A systematic review of the effectiveness of adalimumab

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188 Appendix 10 TABLE 107 Variation 4: TNF inhibitors third (early RA values) (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 48,100 97 5.2549 0.0131 Etan 60,598 117 5.5899 0.0135 Adal+MTX 48,344 98 5.4002 0.0129 Etan+MTX 60,707 118 5.6922 0.0135 Infl+MTX 47,877 93 5.3595 0.0130 Base 16,461 23 4.6139 0.0125 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 31,639 95 0.6409 0.0136 Etan – Base 44,137 114 0.9759 0.0141 Ad+M – Base 31,883 96 0.7863 0.0136 Et+M – Base 44,246 115 1.0782 0.0142 In+M – Base 31,415 91 0.7455 0.0135 Ad+M – Adal 244 130 0.1454 0.0141 Et+M – Etan 109 153 0.1023 0.0150 Etan – Adal 12,498 142 0.3350 0.0145 Et+M – Ad+M 12,363 142 0.2919 0.0145 Ad+M – In+M 467 127 0.0408 0.0140 Et+M – In+M 12,831 141 0.3327 0.0145 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 49,400 47,300 to 51,600 Etan – Base 45,200 43,900 to 46,600 Ad+M – Base 40,500 39,200 to 42,000 Et+M – Base 41,000 40,000 to 42,200 In+M – Base 42,100 40,600 to 43,700 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 37,300 34,200 to 41,000 Et+M – Ad+M 42,400 38,400 to 47,200 Ad+M – In+M 11,500 6,110 to 92,700 Et+M – In+M 38,600 35,400 to 42,400 TABLE 108 Variation 4: TNF inhibitors third (late RA values) (200,000 patients) Option Cost (£) QSE QALYs QSE Adal 47,417 68 4.5550 0.0092 Etan 59,961 83 5.0714 0.0094 Adal+MTX 47,781 69 4.8287 0.0091 Etan+MTX 60,035 83 5.0689 0.0095 Infl+MTX 47,068 66 4.5821 0.0092 Base 16,382 16 4.6147 0.0088 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 31,034 67 –0.0596 0.0093 Etan – Base 43,579 80 0.4568 0.0097 Ad+M – Base 31,399 67 0.2141 0.0093 Et+M – Base 43,652 81 0.4542 0.0097 In+M – Base 30,686 64 –0.0325 0.0093 Ad+M – Adal 364 90 0.2737 0.0093 Et+M – Etan 73 107 –0.0025 0.0101 Etan – Adal 12,545 99 0.5164 0.0097 Et+M – Ad+M 12,254 100 0.2402 0.0098 In+M – Ad+M 713 89 0.2466 0.0094 Et+M – In+M 12,967 98 0.4867 0.0098 continued
TABLE 108 Variation 4: TNF inhibitors third (late RA values) (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 Comparison ICER (£ per QALY) Quasi-CI Adal – Base Base dominates Adal Etan – Base 95,400 91,500 to 99,600 Ad+M – Base 147,000 135,000 to 161,000 Et+M – Base 96,100 92,100 to 100,000 In+M – Base Base dominates Infl+MTX Ad+M – Adal 1,330 665 to 2,000 Et+M – Etan Comparison is inconclusive Etan – Adal 24,300 23,300 to 25,300 Et+M – Ad+M 51,000 47,100 to 55,700 In+M – Ad+M 2,890 2,140 to 3,640 Et+M – In+M 26,600 25,500 to 27,800 TABLE 109 Variation 4: TNF inhibitors last (20,000 patients) Option Cost (£) QSE QALYs QSE Adal 35,868 213 1.0425 0.0190 Etan 48,695 259 1.9916 0.0222 Adal+MTX 36,319 215 1.3258 0.0191 Etan+MTX 48,859 259 2.0122 0.0229 Infl+MTX 35,780 206 1.0933 0.0194 Base 2,833 11 0.4757 0.0166 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 33,035 211 0.5668 0.0142 Etan – Base 45,863 256 1.5159 0.0195 Ad+M – Base 33,486 213 0.8501 0.0149 Et+M – Base 46,027 256 1.5365 0.0203 In+M – Base 32,947 204 0.6176 0.0149 Ad+M – Adal 451 291 0.2834 0.0179 Et+M – Etan 164 339 0.0206 0.0258 Etan – Adal 12,827 321 0.9492 0.0217 Et+M – Ad+M 12,541 320 0.6864 0.0231 Ad+M – In+M 539 287 0.2325 0.0186 Et+M – In+M 13,080 316 0.9189 0.0231 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 58,300 55,400 to 61,500 Etan – Base 30,300 29,400 to 31,100 Ad+M – Base 39,400 38,000 to 40,900 Et+M – Base 30,000 29,100 to 30,800 In+M – Base 53,300 50,800 to 56,100 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 13,500 12,600 to 14,400 Et+M – Ad+M 18,300 16,800 to 20,000 Ad+M – In+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 14,200 13,300 to 15,300 189
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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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171. Geborek P, Crnkic M, Petersson
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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
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Page 187 and 188: TABLE 85 Bansback et al., 2005 166
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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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