A systematic review of the effectiveness of adalimumab

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Appendix 10
Variation 5
For this variation, no effect of HAQ on mortality was assumed.
TABLE 110 Variation 5: TNF inhibitors first (2,000,000 patients)
Option Cost (£) QSE QALYs QSE
Adal 51,012 23 9.3150 0.0038
Etan 65,955 28 9.6947 0.0040
Adal+MTX 50,983 23 8.7897 0.0036
Etan+MTX 66,074 28 9.2429 0.0039
Infl+MTX 50,480 22 8.6424 0.0036
Base 16,139 5 8.6245 0.0036
Comparison Diff. cost (£) QSE Diff. QALY QSE
Adal – Base 34,873 23 0.6905 0.0039
Etan – Base 49,817 28 1.0702 0.0040
Ad+M – Base 34,844 23 0.1652 0.0038
Et+M – Base 49,935 28 0.6185 0.0040
In+M – Base 34,341 22 0.0179 0.0038
Adal – Ad+M 29 32 0.5253 0.0039
Et+M – Etan 118 38 –0.4518 0.0041
Etan – Adal 14,943 35 0.3797 0.0041
Et+M – Ad+M 15,091 35 0.4533 0.0040
Ad+M – In+M 503 31 0.1473 0.0038
Et+M – In+M 15,594 35 0.6005 0.0040
Comparison ICER (£ per QALY) Quasi-CI
Adal – Base 50,500 49,900 to 51,100
Etan – Base 46,500 46,200 to 46,900
Ad+M – Base 211,000 202,000 to 221,000
Et+M – Base 80,700 79,700 to 81,800
In+M – Base 1,910,000 1,340,000 to 3,340,000
Adal – Ad+M Adal alone more effective than Adal+MTX; diff. cost not significant
Et+M – Etan Etan alone dominates Etan+MTX
Etan – Adal 39,400 38,500 to 40,200
Et+M – Ad+M 33,300 32,700 to 33,900
Ad+M – In+M 3,410 2,950 to 3,870
Et+M – In+M 26,000 25,600 to 26,300
TABLE 111 Variation 5: TNF inhibitors third (early RA values) (100,000 patients)
Option Cost (£) QSE QALYs QSE
Adal 49,798 100 6.3972 0.0153
Etan 63,034 121 6.9544 0.0163
Adal+MTX 49,814 100 6.5335 0.0153
Etan+MTX 62,915 121 7.0522 0.0163
Infl+MTX 49,551 96 6.4934 0.0153
Base 17,285 23 5.3888 0.0142
Comparison Diff. cost (£) QSE Diff. QALY QSE
Adal – Base 32,513 98 1.0083 0.0152
Etan – Base 45,749 118 1.5656 0.0161
Ad+M – Base 32,529 98 1.1447 0.0152
Et+M – Base 45,630 118 1.6634 0.0162
In+M – Base 32,266 94 1.1046 0.0152
Ad+M – Adal 16 134 0.1364 0.0158
Etan – Et+M 119 158 –0.0978 0.0173
Etan – Adal 13,236 147 0.5573 0.0166
continued