A systematic review of the effectiveness of adalimumab

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196 Appendix 10 TABLE 119 Variation 7: TNF inhibitors third (early RA values) (20,000 patients) Option Cost (£) QSE QALYs QSE Adal 48,650 222 5.4799 0.0317 Etan 61,379 267 6.2553 0.0344 Adal+MTX 48,423 221 5.6541 0.0319 Etan+MTX 61,220 267 6.2992 0.0345 Infl+MTX 48,015 212 5.5708 0.0316 Base 16,317 52 4.2654 0.0289 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 32,334 216 1.2145 0.0287 Etan – Base 45,063 260 1.9899 0.0320 Ad+M – Base 32,107 216 1.3887 0.0289 Et+M – Base 44,904 259 2.0338 0.0320 In+M – Base 31,699 207 1.3054 0.0288 Adal – Ad+M 227 294 –0.1742 0.0316 Etan – Et+M 159 350 –0.0438 0.0365 Etan – Adal 12,729 323 0.7754 0.0341 Et+M – Ad+M 12,797 325 0.6451 0.0343 Ad+M – In+M 408 289 0.0833 0.0316 Et+M – In+M 13,205 319 0.7284 0.0342 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 26,600 25,400 to 28,000 Etan – Base 22,600 21,900 to 23,400 Ad+M – Base 23,100 22,200 to 24,200 Et+M – Base 22,100 21,400 to 22,800 In+M – Base 24,300 23,200 to 25,500 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 16,400 14,900 to 18,300 Et+M – Ad+M 19,800 17,700 to 22,500 Ad+M – In+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 18,100 16,400 to 20,300 TABLE 120 Variation 7: TNF inhibitors third (late RA values) (40,000 patients) Option Cost (£) QSE QALYs QSE Adal 47,660 155 4.8371 0.0221 Etan 60,622 189 5.7193 0.0239 Adal+MTX 48,035 155 5.0840 0.0221 Etan+MTX 60,555 189 5.6993 0.0241 Infl+MTX 47,352 149 4.8462 0.0223 Base 16,295 36 4.3003 0.0206 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 31,365 151 0.5367 0.0188 Etan – Base 44,327 183 1.4190 0.0213 Ad+M – Base 31,740 152 0.7837 0.0193 Et+M – Base 44,260 183 1.3990 0.0216 In+M – Base 31,058 145 0.5459 0.0190 Ad+M – Adal 375 205 0.2470 0.0198 Etan – Et+M 67 244 0.0200 0.0239 Etan – Adal 12,962 227 0.8823 0.0218 Et+M – Ad+M 12,520 227 0.6153 0.0223 Ad+M – In+M 682 202 0.2378 0.0202 Et+M – In+M 13,203 223 0.8531 0.0222 continued
TABLE 120 Variation 7: TNF inhibitors third (late RA values) (40,000 patients) (cont’d) © Queen’s Printer and Controller <strong>of</strong> HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 58,400 54,600 to 62,900 Etan – Base 31,200 30,300 to 32,200 Ad+M – Base 40,500 38,600 to 42,600 Et+M – Base 31,600 30,700 to 32,700 In+M – Base 56,900 53,200 to 61,200 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 14,700 13,900 to 15,600 Et+M – Ad+M 20,300 18,800 to 22,100 Ad+M – In+M 2,870 1,100 to 4,640 Et+M – In+M 15,500 14,600 to 16,500 TABLE 121 Variation 7: TNF inhibitors last (20,000 patients) Option Cost (£) QSE QALYs QSE Adal 36,804 218 1.9159 0.0224 Etan 49,802 263 3.0181 0.0269 Adal+MTX 37,244 220 2.2088 0.0229 Etan+MTX 49,641 264 3.0262 0.0274 Infl+MTX 36,534 208 1.9573 0.0229 Base 2,900 11 1.0582 0.0184 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 33,904 216 0.8577 0.0162 Etan – Base 46,902 260 1.9599 0.0227 Ad+M – Base 34,344 218 1.1506 0.0175 Et+M – Base 46,741 261 1.9680 0.0236 In+M – Base 33,634 206 0.8990 0.0171 Ad+M – Adal 440 299 0.2929 0.0209 Etan – Et+M 161 348 –0.0081 0.0301 Etan – Adal 12,998 324 1.1022 0.0251 Et+M – Ad+M 12,397 328 0.8174 0.0267 Ad+M – In+M 710 293 0.2515 0.0215 Et+M – In+M 13,107 320 1.0689 0.0266 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 39,500 38,000 to 41,200 Etan – Base 23,900 23,300 to 24,600 Ad+M – Base 29,800 28,900 to 30,900 Et+M – Base 23,800 23,100 to 24,400 In+M – Base 37,400 36,000 to 39,000 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Etan – Et+M Comparison is inconclusive Etan – Adal 11,800 11,000 to 12,600 Et+M – Ad+M 15,200 14,000 to 16,600 Ad+M – In+M 2,820 442 to 5,200 Et+M – In+M 12,300 11,500 to 13,200 197
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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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Appendix 3 © Queen’s Printer and
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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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