A systematic review of the effectiveness of adalimumab

TABLE 117 Variation 6: TNF inhibitors last (40,000 patients) (cont’d)
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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
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