A systematic review of the effectiveness of adalimumab

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200 Appendix 10 TABLE 125 Variation 8: TNF inhibitors last (20,000 patients) Option Cost (£) QSE QALYs QSE Adal 36,186 215 1.8335 0.0220 Etan 49,049 262 2.9338 0.0268 Adal+MTX 36,117 215 2.1086 0.0223 Etan+MTX 49,070 263 2.9087 0.0271 Infl+MTX 35,434 205 1.8284 0.0221 Base 2,812 11 0.9754 0.0180 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 33,374 213 0.8581 0.0159 Etan – Base 46,237 259 1.9584 0.0227 Ad+M – Base 33,305 213 1.1332 0.0171 Et+M – Base 46,258 260 1.9333 0.0233 In+M – Base 32,622 203 0.8530 0.0164 Adal – Ad+M 69 292 –0.2751 0.0205 Et+M – Etan 21 343 –0.0251 0.0297 Etan – Adal 12,863 320 1.1003 0.0250 Et+M – Ad+M 12,953 323 0.8002 0.0264 Ad+M – In+M 683 286 0.2802 0.0210 Et+M – In+M 13,636 317 1.0804 0.0260 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 38,900 37,400 to 40,500 Etan – Base 23,600 23,000 to 24,200 Ad+M – Base 29,400 28,500 to 30,400 Et+M – Base 23,900 23,300 to 24,600 In+M – Base 38,200 36,800 to 39,900 Adal – Ad+M Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 11,700 10,900 to 12,500 Et+M – Ad+M 16,200 15,000 to 17,600 Ad+M – In+M 2,440 364 to 4,510 Et+M – In+M 12,600 11,800 to 13,500 Variation 9 For this variation, survival times on conventional DMARDs were reduced by 50%. TABLE 126 Variation 9: TNF inhibitors first (40,000 patients) Option Cost (£) QSE QALYs QSE Adal 49,448 160 8.3841 0.0254 Etan 63,898 194 8.8538 0.0267 Adal+MTX 49,982 163 7.8754 0.0241 Etan+MTX 63,770 197 8.4103 0.0259 Infl+MTX 48,828 154 7.6905 0.0240 Base 15,589 32 7.5443 0.0235 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 33,859 157 0.8398 0.0254 Etan – Base 48,309 190 1.3095 0.0266 Ad+M – Base 34,393 161 0.3311 0.0247 Et+M – Base 48,181 192 0.8660 0.0260 In+M – Base 33,239 152 0.1462 0.0246 Ad+M – Adal 533 219 –0.5087 0.0256 Etan – Et+M 127 261 0.4435 0.0276 continued
TABLE 126 Variation 9: TNF inhibitors first (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 Etan – Adal 14,449 241 0.4697 0.0270 Et+M – Ad+M 13,789 244 0.5349 0.0261 Ad+M – In+M 1,154 217 0.1849 0.0248 Et+M – In+M 14,943 237 0.7198 0.0262 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 40,300 38,000 to 42,900 Etan – Base 36,900 35,400 to 38,500 Ad+M – Base 104,000 90,400 to 122,000 Et+M – Base 55,600 52,500 to 59,200 In+M – Base 227,000 170,000 to 343,000 Ad+M – Adal Adal alone dominates Adal+MTX Etan – Et+M Etan+MTX more effective than Etan alone; diff. cost not significant Etan – Adal 30,800 27,500 to 34,900 Et+M – Ad+M 25,800 23,400 to 28,800 Ad+M – In+M 6,240 3,350 to 9,130 Et+M – In+M 20,800 19,200 to 22,600 TABLE 127 Variation 9: TNF inhibitors third (early RA values) (40,000 patients) Option Cost (£) QSE QALYs QSE Adal 48,652 157 5.9790 0.0225 Etan 61,597 190 6.6380 0.0245 Adal+MTX 48,533 157 6.1027 0.0225 Etan+MTX 61,625 191 6.7264 0.0245 Infl+MTX 48,384 150 6.0913 0.0225 Base 15,954 32 4.8044 0.0202 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 32,698 155 1.1746 0.0211 Etan – Base 45,643 185 1.8336 0.0231 Ad+M – Base 32,580 155 1.2983 0.0212 Et+M – Base 45,671 187 1.9220 0.0234 In+M – Base 32,430 148 1.2869 0.0212 Adal – Ad+M 118 211 –0.1237 0.0230 Et+M – Etan 27 249 0.0884 0.0263 Etan – Adal 12,945 232 0.6590 0.0246 Et+M – Ad+M 13,091 232 0.6238 0.0248 Ad+M – In+M 150 207 0.0114 0.0229 Et+M – In+M 13,241 229 0.6351 0.0248 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 27,800 26,800 to 28,900 Etan – Base 24,900 24,300 to 25,600 Ad+M – Base 25,100 24,300 to 26,000 Et+M – Base 23,800 23,200 to 24,400 In+M – Base 25,200 24,400 to 26,100 Adal – Ad+M 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 19,600 18,100 to 21,400 Et+M – Ad+M 21,000 19,300 to 23,000 Ad+M – In+M Comparison is inconclusive Et+M – In+M 20,800 19,200 to 22,800 201
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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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TABLE 69 Studies excluded from clin
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148 Appendix 4 TABLE 71 Meta-analys
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A systematic review of the effectiveness of adalimumab

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