A systematic review of the effectiveness of adalimumab

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202 Appendix 10 TABLE 128 Variation 9: TNF inhibitors third (late RA values) (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 47,766 98 5.2589 0.0139 Etan 60,801 119 6.0926 0.0150 Adal+MTX 48,120 99 5.5438 0.0139 Etan+MTX 60,803 120 6.0658 0.0152 Infl+MTX 47,372 94 5.2900 0.0141 Base 15,905 20 4.7814 0.0127 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 31,861 97 0.4775 0.0125 Etan – Base 44,895 117 1.3112 0.0139 Ad+M – Base 32,215 97 0.7624 0.0127 Et+M – Base 44,898 117 1.2844 0.0140 In+M – Base 31,466 92 0.5086 0.0126 Ad+M – Adal 354 132 0.2849 0.0131 Et+M – Etan 2 155 –0.0269 0.0154 Etan – Adal 13,035 145 0.8337 0.0142 Et+M – Ad+M 12,683 145 0.5220 0.0145 Ad+M – In+M 748 129 0.2538 0.0132 Et+M – In+M 13,431 142 0.7758 0.0145 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 66,700 63,400 to 70,400 Etan – Base 34,200 33,500 to 35,000 Ad+M – Base 42,300 40,900 to 43,700 Et+M – Base 35,000 34,200 to 35,800 In+M – Base 61,900 58,900 to 65,100 Ad+M – Adal 1,240 311 to 2,170 Et+M – Etan Comparison is inconclusive Etan – Adal 15,600 15,000 to 16,300 Et+M – Ad+M 24,300 22,900 to 25,900 Ad+M – In+M 2,950 1,890 to 4,010 Et+M – In+M 17,300 16,600 to 18,100 TABLE 129 Variation 9: TNF inhibitors last (20,000 patients) Option Cost (£) QSE QALYs QSE Adal 37,473 220 2.2513 0.0234 Etan 51,062 267 3.3807 0.0277 Adal+MTX 37,834 222 2.5615 0.0238 Etan+MTX 50,984 269 3.3579 0.0284 Infl+MTX 36,998 211 2.2586 0.0236 Base 3,020 12 1.3562 0.0200 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 34,454 218 0.8951 0.0170 Etan – Base 48,042 265 2.0245 0.0235 Ad+M – Base 34,814 220 1.2053 0.0183 Et+M – Base 47,964 267 2.0018 0.0245 In+M – Base 33,979 209 0.9025 0.0174 Ad+M – Adal 361 302 0.3102 0.0216 Etan – Et+M 78 357 0.0228 0.0306 Etan – Adal 13,588 331 1.1294 0.0258 Et+M – Ad+M 13,150 334 0.7965 0.0274 Ad+M – In+M 836 297 0.3028 0.0219 Et+M – In+M 13,985 330 1.0993 0.0271 continued
TABLE 129 Variation 9: TNF inhibitors last (20,000 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 38,500 37,000 to 40,100 Etan – Base 23,700 23,100 to 24,400 Ad+M – Base 28,900 28,000 to 29,900 Et+M – Base 24,000 23,300 to 24,600 In+M – Base 37,700 36,200 to 39,200 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Etan – Et+M Comparison is inconclusive Etan – Adal 12,000 11,200 to 12,800 Et+M – Ad+M 16,500 15,200 to 18,100 Ad+M – In+M 2,760 757 to 4,760 Et+M – In+M 12,700 11,900 to 13,700 Variation 10 In this variation, long-term survival times on conventional DMARDs were increased by 50% compared to <strong>the</strong> base case. TABLE 130 Variation 10: TNF inhibitors first (1,000,000 patients) Option Cost (£) QSE QALYs QSE Adal 49,349 32 9.1995 0.0054 Etan 63,709 39 9.4888 0.0056 Adal+MTX 49,406 33 8.8607 0.0052 Etan+MTX 63,822 40 9.1948 0.0055 Infl+MTX 48,782 31 8.6889 0.0052 Base 15,056 7 8.6331 0.0051 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 34,293 32 0.5664 0.0055 Etan – Base 48,653 38 0.8556 0.0056 Ad+M – Base 34,351 32 0.2275 0.0054 Et+M – Base 48,766 39 0.5617 0.0056 In+M – Base 33,727 31 0.0558 0.0054 Ad+M – Adal 57 44 –0.3389 0.0055 Et+M – Etan 113 52 –0.2940 0.0057 Etan – Adal 14,360 48 0.2892 0.0057 Et+M – Ad+M 14,415 49 0.3341 0.0056 Ad+M – In+M 624 43 0.1717 0.0054 Et+M – In+M 15,039 48 0.5059 0.0056 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 60,500 59,400 to 61,700 Etan – Base 56,900 56,100 to 57,600 Ad+M – Base 151,000 144,000 to 158,000 Et+M – Base 86,800 85,100 to 88,600 In+M – Base 605,000 507,000 to 749,000 Ad+M – Adal Adal alone more effective than Adal+MTX; diff. cost not significant Et+M – Etan Etan alone dominates Etan+MTX Etan – Adal 49,700 47,800 to 51,700 Et+M – Ad+M 43,100 41,700 to 44,700 Ad+M – In+M 3,630 3,080 to 4,190 Et+M – In+M 29,700 29,100 to 30,400 203
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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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150 Appendix 4 TABLE 73 Meta-analys
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A systematic review of the effectiveness of adalimumab

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