A systematic review of the effectiveness of adalimumab

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210 Appendix 10 TABLE 140 Variation 12: TNF inhibitors third (late RA values) (40,000 patients) Option Cost (£) QSE QALYs QSE Adal 53,637 174 5.6256 0.0237 Etan 66,384 201 6.4225 0.0252 Adal+MTX 53,914 174 5.9687 0.0237 Etan+MTX 66,339 201 6.3959 0.0256 Infl+MTX 53,072 167 5.6571 0.0238 Base 16,470 36 5.3761 0.0217 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 37,167 169 0.2495 0.0227 Etan – Base 49,914 194 1.0464 0.0244 Ad+M – Base 37,443 170 0.5926 0.0230 Et+M – Base 49,868 195 1.0198 0.0249 In+M – Base 36,601 162 0.2811 0.0230 Ad+M – Adal 277 228 0.3431 0.0233 Etan – Et+M 45 254 0.0266 0.0262 Etan – Adal 12,747 242 0.7969 0.0245 Et+M – Ad+M 12,425 244 0.4272 0.0252 Ad+M – In+M 842 223 0.3116 0.0236 Et+M – In+M 13,267 237 0.7387 0.0251 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 149,000 126,000 to 182,000 Etan – Base 47,700 45,500 to 50,100 Ad+M – Base 63,200 58,600 to 68,500 Et+M – Base 48,900 46,600 to 51,400 In+M – Base 130,000 112,000 to 156,000 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Etan – Et+M Comparison is inconclusive Etan – Adal 16,000 14,900 to 17,200 Et+M – Ad+M 29,100 25,900 to 33,200 Ad+M – In+M 2,700 1,210 to 4,190 Et+M – In+M 18,000 16,700 to 19,500 TABLE 141 Variation 12: TNF inhibitors last (20,000 patients) Option Cost (£) QSE QALYs QSE Adal 42,047 244 2.0899 0.0236 Etan 55,244 282 3.3320 0.0287 Adal+MTX 42,667 244 2.4122 0.0240 Etan+MTX 55,230 282 3.3098 0.0292 Infl+MTX 41,638 234 2.0948 0.0241 Base 2,865 11 1.0366 0.0184 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 39,182 241 1.0533 0.0178 Etan – Base 52,379 278 2.2954 0.0250 Ad+M – Base 39,802 242 1.3756 0.0189 Et+M – Base 52,365 279 2.2732 0.0257 In+M – Base 38,773 232 1.0582 0.0186 Ad+M – Adal 620 327 0.3223 0.0231 Etan – Et+M 13 365 0.0222 0.0329 Etan – Adal 13,197 349 1.2421 0.0282 Et+M – Ad+M 12,563 349 0.8976 0.0293 Ad+M – In+M 1,030 322 0.3174 0.0239 Et+M – In+M 13,593 343 1.2150 0.0292 continued
TABLE 141 Variation 12: TNF inhibitors last (20,000 patients) (cont’d) © Queen’s Printer and Controller of HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 37,200 35,900 to 38,600 Etan – Base 22,800 22,300 to 23,400 Ad+M – Base 28,900 28,100 to 29,800 Et+M – Base 23,000 22,500 to 23,600 In+M – Base 36,600 35,300 to 38,000 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 10,600 9,880 to 11,400 Et+M – Ad+M 14,000 12,900 to 15,300 Ad+M – In+M 3,240 1,160 to 5,330 Et+M – In+M 11,200 10,400 to 12,000 Variation 13 In this variation, the possibility was considered of reviewing the effectiveness of TNF inhibitors at 12 weeks rather than at 24 weeks. For the purpose of this analysis, the proportion of short-term quitters was left unchanged. TABLE 142 Variation 13: TNF inhibitors first (4,000,000 patients) Option Cost (£) QSE QALYs QSE Adal 48,362 16 8.9326 0.0027 Etan 63,011 20 9.2897 0.0028 Adal+MTX 48,531 16 8.4856 0.0025 Etan+MTX 63,129 20 8.9015 0.0027 Infl+MTX 47,903 16 8.3299 0.0025 Base 15,338 3 8.3150 0.0025 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 33,024 16 0.6176 0.0027 Etan – Base 47,673 19 0.9747 0.0028 Ad+M – Base 33,194 16 0.1706 0.0026 Et+M – Base 47,791 19 0.5864 0.0027 In+M – Base 32,566 15 0.0149 0.0026 Ad+M – Adal 170 22 –0.4470 0.0027 Et+M – Etan 118 26 –0.3882 0.0028 Etan – Adal 14,649 24 0.3571 0.0028 Et+M – Ad+M 14,598 25 0.4158 0.0027 Ad+M – In+M 628 22 0.1557 0.0026 Et+M – In+M 15,226 24 0.5716 0.0027 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 53,500 53,000 to 53,900 Etan – Base 48,900 48,600 to 49,200 Ad+M – Base 195,000 189,000 to 201,000 Et+M – Base 81,500 80,700 to 82,300 In+M – Base 2,190,000 1,620,000 to 3,380,000 Ad+M – Adal Adal alone dominates Adal+MTX Et+M – Etan Etan alone dominates Etan+MTX Etan – Adal 41,000 40,400 to 41,700 Et+M – Ad+M 35,100 34,600 to 35,600 Ad+M – In+M 4,030 3,720 to 4,340 Et+M – In+M 26,600 26,400 to 26,900 211
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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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Ovid MEDLINE(R) 1966 to February we
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A systematic review of the effectiveness of adalimumab

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