A systematic review of the effectiveness of adalimumab

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190 Appendix 10 Variation 5 For this variation, no effect <strong>of</strong> 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
TABLE 111 Variation 5: TNF inhibitors third (early RA values) (100,000 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 – Ad+M 13,101 148 0.5187 0.0166 Ad+M – In+M 263 131 0.0401 0.0158 Et+M – In+M 13,364 145 0.5588 0.0166 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 32,200 31,300 to 33,300 Etan – Base 29,200 28,600 to 29,900 Ad+M – Base 28,400 27,700 to 29,200 Et+M – Base 27,400 26,900 to 28,000 In+M – Base 29,200 28,400 to 30,100 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 23,800 22,300 to 25,400 Et+M – Ad+M 25,300 23,700 to 27,100 Ad+M – In+M 6,560 Dominates to 14,900 Et+M – In+M 23,900 22,500 to 25,500 TABLE 112 Variation 5: TNF inhibitors third (late RA values) (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 49,757 99 5.7131 0.0151 Etan 62,853 121 6.4337 0.0159 Adal+MTX 49,833 100 5.9854 0.0151 Etan+MTX 62,864 121 6.4188 0.0162 Infl+MTX 49,590 96 5.7287 0.0152 Base 17,271 23 5.3807 0.0142 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 32,487 98 0.3324 0.0145 Etan – Base 45,582 118 1.0530 0.0154 Ad+M – Base 32,562 98 0.6047 0.0146 Et+M – Base 45,594 118 1.0381 0.0157 In+M – Base 32,319 94 0.3481 0.0146 Ad+M – Adal 75 134 0.2723 0.0147 Et+M – Etan 11 158 –0.0149 0.0164 Etan – Adal 13,096 147 0.7206 0.0154 Et+M – Ad+M 13,032 148 0.4334 0.0158 Ad+M – In+M 243 131 0.2566 0.0148 Et+M – In+M 13,274 145 0.6900 0.0158 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 97,700 89,900 to 107,000 Etan – Base 43,300 42,000 to 44,600 Ad+M – Base 53,800 51,400 to 56,600 Et+M – Base 43,900 42,600 to 45,300 In+M – Base 92,900 85,600 to 101,000 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 18,200 17,300 to 19,100 Et+M – Ad+M 30,100 27,900 to 32,600 Ad+M – In+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 19,200 18,300 to 20,300 191
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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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216. Schotte H, Willeke P, Mickholz
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Page 221 and 222: TABLE 132 Variation 10: TNF inhibit
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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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