A systematic review of the effectiveness of adalimumab

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208 Appendix 10 TABLE 137 Variation 11: TNF inhibitors last (20,000 patients) Option Cost (£) QSE QALYs QSE Adal 26,797 159 1.5818 0.0202 Etan 38,999 222 2.4968 0.0240 Adal+MTX 26,804 163 1.7647 0.0206 Etan+MTX 38,450 220 2.4194 0.0240 Infl+MTX 26,971 155 1.5903 0.0205 Base 2,850 11 1.0352 0.0185 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 23,946 158 0.5466 0.0135 Etan – Base 36,149 220 1.4617 0.0190 Ad+M – Base 23,954 161 0.7295 0.0144 Et+M – Base 35,599 218 1.3842 0.0193 In+M – Base 24,121 154 0.5551 0.0138 Ad+M – Adal 7 222 0.1829 0.0163 Etan – Et+M 550 300 0.0775 0.0243 Etan – Adal 12,202 265 0.9151 0.0205 Et+M – Ad+M 11,645 265 0.6547 0.0213 In+M – Ad+M 167 220 –0.1744 0.0166 Et+M – In+M 11,479 261 0.8291 0.0209 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 43,800 41,700 to 46,200 Etan – Base 24,700 24,000 to 25,500 Ad+M – Base 32,800 31,500 to 34,300 Et+M – Base 25,700 25,000 to 26,500 In+M – Base 43,500 41,300 to 45,800 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Etan alone more effective than Etan+MTX; diff. cost not significant Etan – Adal 13,300 12,600 to 14,200 Et+M – Ad+M 17,800 16,500 to 19,300 In+M – Ad+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 13,800 13,000 to 14,900 Variation 12 In this variation, survival times on TNF inhibitors were increased by 50% compared to <strong>the</strong> base case. TABLE 138 Variation 12: TNF inhibitors first (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 56,493 116 9.0677 0.0172 Etan 70,886 132 9.4132 0.0179 Adal+MTX 56,728 117 8.7667 0.0164 Etan+MTX 71,163 133 9.1543 0.0174 Infl+MTX 55,594 111 8.5600 0.0164 Base 15,320 21 8.3179 0.0158 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 41,173 113 0.7498 0.0172 Etan – Base 55,566 129 1.0953 0.0177 Ad+M – Base 41,408 115 0.4488 0.0168 Et+M – Base 55,843 129 0.8364 0.0175 In+M – Base 40,275 109 0.2421 0.0168 Ad+M – Adal 235 156 –0.3010 0.0174 Et+M – Etan 277 173 –0.2589 0.0184 continued
TABLE 138 Variation 12: TNF inhibitors first (100,000 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 14,393 164 0.3455 0.0180 Et+M – Ad+M 14,435 166 0.3876 0.0177 Ad+M – In+M 1,133 154 0.2067 0.0171 Et+M – In+M 15,569 163 0.5942 0.0177 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 54,900 52,500 to 57,600 Etan – Base 50,700 49,100 to 52,400 Ad+M – Base 92,300 85,800 to 99,800 Et+M – Base 66,800 64,100 to 69,700 In+M – Base 166,000 146,000 to 193,000 Ad+M – Adal 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 41,700 37,600 to 46,600 Et+M – Ad+M 37,200 34,000 to 41,100 Ad+M – In+M 5,480 3,740 to 7,220 Et+M – In+M 26,200 24,600 to 28,000 TABLE 139 Variation 12: TNF inhibitors third (early RA values) (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 54,611 111 6.5295 0.0154 Etan 67,263 127 7.0841 0.0165 Adal+MTX 54,797 112 6.7368 0.0154 Etan+MTX 67,427 128 7.2198 0.0165 Infl+MTX 54,229 107 6.6898 0.0154 Base 16,488 23 5.3802 0.0137 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 38,123 108 1.1492 0.0151 Etan – Base 50,775 123 1.7039 0.0161 Ad+M – Base 38,309 109 1.3566 0.0153 Et+M – Base 50,939 124 1.8396 0.0162 In+M – Base 37,741 104 1.3096 0.0152 Ad+M – Adal 186 147 0.2074 0.0162 Et+M – Etan 164 162 0.1357 0.0176 Etan – Adal 12,652 156 0.5547 0.0169 Et+M – Ad+M 12,630 156 0.4830 0.0169 Ad+M – In+M 568 144 0.0470 0.0162 Et+M – In+M 13,198 153 0.5300 0.0169 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 33,200 32,300 to 34,100 Etan – Base 29,800 29,200 to 30,400 Ad+M – Base 28,200 27,600 to 28,900 Et+M – Base 27,700 27,200 to 28,200 In+M – Base 28,800 28,100 to 29,500 Ad+M – Adal 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 22,800 21,400 to 24,400 Et+M – Ad+M 26,100 24,300 to 28,200 Ad+M – In+M 12,100 6,510 to 83,000 Et+M – In+M 24,900 23,300 to 26,700 209
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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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152 Appendix 4 Infliximab versus pl
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154 Appendix 4 Infliximab plus MTX
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A systematic review of the effectiveness of adalimumab

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