A systematic review of the effectiveness of adalimumab

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Appendix 10
TABLE 113 Variation 5: TNF inhibitors last (20,000 patients)
Option Cost (£) QSE QALYs QSE
Adal 38,154 224 1.6229 0.0230
Etan 51,491 271 2.8279 0.0280
Adal+MTX 37,604 223 1.9000 0.0234
Etan+MTX 51,024 270 2.7969 0.0282
Infl+MTX 37,743 213 1.6469 0.0235
Base 3,258 12 0.7532 0.0194
Comparison Diff. cost (£) QSE Diff. QALY QSE
Adal – Base 34,896 223 0.8697 0.0163
Etan – Base 48,233 269 2.0746 0.0237
Ad+M – Base 34,346 221 1.1468 0.0174
Et+M – Base 47,766 267 2.0437 0.0243
In+M – Base 34,485 212 0.8937 0.0172
Adal – Ad+M 550 305 –0.2771 0.0207
Etan – Et+M 467 360 0.0309 0.0311
Etan – Adal 13,338 335 1.2049 0.0258
Et+M – Ad+M 13,420 334 0.8970 0.0272
In+M – Ad+M 139 298 –0.2530 0.0214
Et+M – In+M 13,281 329 1.1500 0.0269
Comparison ICER (£ per QALY) Quasi-CI
Adal – Base 40,100 38,600 to 41,800
Etan – Base 23,200 22,700 to 23,900
Ad+M – Base 30,000 29,000 to 31,000
Et+M – Base 23,400 22,800 to 24,000
In+M – Base 38,600 37,100 to 40,200
Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant
Et+M – Etan Comparison is inconclusive
Etan – Adal 11,100 10,300 to 11,800
Et+M – Ad+M 15,000 13,900 to 16,200
In+M – Ad+M Adal+MTX more effective than Infl+MTX; diff. cost not significant
Et+M – In+M 11,500 10,800 to 12,300
Variation 6
In this variation, a mortality ratio of 2.73 HAQ was assumed, as reported by Sokka and colleagues. 199
TABLE 114 Variation 6: TNF inhibitors first (200,000 patients)
Option Cost (£) QSE QALYs QSE
Adal 45,580 69 7.9578 0.0116
Etan 58,199 84 8.2524 0.0121
Adal+MTX 46,298 71 7.7037 0.0110
Etan+MTX 58,780 85 8.0276 0.0116
Infl+MTX 45,229 67 7.5142 0.0110
Base 13,334 15 7.4406 0.0107
Comparison Diff. cost (£) QSE Diff. QALY QSE
Adal – Base 32,246 68 0.5172 0.0113
Etan – Base 44,866 81 0.8118 0.0116
Ad+M – Base 32,965 69 0.2631 0.0110
Et+M – Base 45,447 82 0.5870 0.0114
In+M – Base 31,896 65 0.0737 0.0109
Ad+M – Adal 718 93 –0.2541 0.0113
Et+M – Etan 581 109 –0.2248 0.0121
continued