A systematic review of the effectiveness of adalimumab

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194 Appendix 10 TABLE 116 Variation 6: TNF inhibitors third (late RA values) (1,000,000 patients) Option Cost (£) QSE QALYs QSE Adal 41,814 29 5.1891 0.0045 Etan 54,024 36 5.8965 0.0047 Adal+MTX 43,010 29 5.4874 0.0044 Etan+MTX 53,985 36 5.8899 0.0048 Infl+MTX 41,754 28 5.2320 0.0045 Base 14,422 7 5.1488 0.0041 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 27,392 28 0.0403 0.0042 Etan – Base 39,602 34 0.7477 0.0045 Ad+M – Base 28,588 28 0.3386 0.0043 Et+M – Base 39,563 34 0.7410 0.0046 In+M – Base 27,333 27 0.0832 0.0043 Ad+M – Adal 1,196 38 0.2983 0.0043 Etan – Et+M 39 45 0.0066 0.0049 Etan – Adal 12,210 41 0.7074 0.0046 Et+M – Ad+M 10,976 42 0.4025 0.0047 Ad+M – In+M 1,255 37 0.2554 0.0044 Et+M – In+M 12,231 41 0.6579 0.0047 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 680,000 562,000 to 861,000 Etan – Base 53,000 52,300 to 53,600 Ad+M – Base 84,400 82,400 to 86,600 Et+M – Base 53,400 52,700 to 54,100 In+M – Base 329,000 298,000 to 366,000 Ad+M – Adal 4,010 3,730 to 4,290 Et+M – Etan Comparison is inconclusive Etan – Adal 17,300 17,000 to 17,500 Et+M – Ad+M 27,300 26,600 to 28,000 Ad+M – In+M 4,910 4,580 to 5,250 Et+M – In+M 18,600 18,300 to 18,900 TABLE 117 Variation 6: TNF inhibitors last (40,000 patients) Option Cost (£) QSE QALYs QSE Adal 31,938 141 2.3301 0.0146 Etan 45,099 177 3.4063 0.0183 Adal+MTX 33,386 144 2.5975 0.0149 Etan+MTX 44,820 177 3.3885 0.0185 Infl+MTX 32,290 137 2.4002 0.0151 Base 2,037 7 1.5331 0.0116 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 29,901 140 0.7970 0.0111 Etan – Base 43,061 175 1.8731 0.0158 Ad+M – Base 31,349 143 1.0643 0.0117 Et+M – Base 42,783 175 1.8553 0.0161 In+M – Base 30,253 135 0.8671 0.0117 Ad+M – Adal 1,448 192 0.2674 0.0142 Etan – Et+M 278 233 0.0178 0.0210 Etan – Adal 13,161 213 1.0762 0.0176 Et+M – Ad+M 11,434 216 0.7910 0.0182 Ad+M – In+M 1,096 189 0.1973 0.0147 Et+M – In+M 12,530 210 0.9883 0.0183 continued
TABLE 117 Variation 6: TNF inhibitors last (40,000 patients) (cont’d) © Queen’s Printer and Controller of HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 37,500 36,500 to 38,600 Etan – Base 23,000 22,600 to 23,400 Ad+M – Base 29,500 28,800 to 30,200 Et+M – Base 23,100 22,600 to 23,500 In+M – Base 34,900 33,900 to 35,900 Ad+M – Adal 5,420 3,870 to 6,970 Et+M – Etan Comparison is inconclusive Etan – Adal 12,200 11,700 to 12,800 Et+M – Ad+M 14,500 13,600 to 15,400 Ad+M – In+M 5,560 3,470 to 7,640 Et+M – In+M 12,700 12,100 to 13,300 Variation 7 In this variation, the effectiveness of conventional DMARDs was reduced by 50%. This was done by reducing the a parameter for HAQ multiplier by 50%, keeping the value of a + b fixed. For example, for leflunomide a = 0.57 and b = 0.65. This was changed to a = 0.285 and b = 0.935. TABLE 118 Variation 7: TNF inhibitors first (40,000 patients) Option Cost (£) QSE QALYs QSE Adal 49,297 161 7.5581 0.0248 Etan 63,619 196 8.1659 0.0264 Adal+MTX 49,206 162 7.4410 0.0242 Etan+MTX 64,015 198 8.0980 0.0259 Infl+MTX 49,286 156 7.3395 0.0242 Base 15,139 34 6.5733 0.0234 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 34,158 158 0.9848 0.0234 Etan – Base 48,480 192 1.5926 0.0248 Ad+M – Base 34,067 160 0.8677 0.0230 Et+M – Base 48,875 193 1.5247 0.0248 In+M – Base 34,147 154 0.7662 0.0229 Adal – Ad+M 92 220 0.1171 0.0242 Et+M – Etan 395 261 –0.0679 0.0269 Etan – Adal 14,322 241 0.6078 0.0257 Et+M – Ad+M 14,809 244 0.6570 0.0255 In+M – Ad+M 80 216 –0.1015 0.0240 Et+M – In+M 14,729 241 0.7585 0.0255 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 34,700 33,100 to 36,400 Etan – Base 30,400 29,500 to 31,500 Ad+M – Base 39,300 37,300 to 41,500 Et+M – Base 32,100 31,000 to 33,200 In+M – Base 44,600 42,000 to 47,400 Adal – Ad+M Adal alone more effective than Adal+MTX; diff. cost not significant Et+M – Etan Etan alone more effective than Etan +MTX; diff. cost not significant Etan – Adal 23,600 21,600 to 25,900 Et+M – Ad+M 22,500 20,800 to 24,600 In+M – Ad+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 19,400 18,100 to 21,000 195
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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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The Health Assessment Questionnaire
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Cochrane Library (CENTRAL) 2005 Iss
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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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