A systematic review of the effectiveness of adalimumab

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212 Appendix 10 TABLE 143 Variation 13: TNF inhibitors third (early RA values) (200,000 patients) Option Cost (£) QSE QALYs QSE Adal 47,317 70 6.2908 0.0106 Etan 60,211 85 6.8125 0.0112 Adal+MTX 47,436 70 6.4180 0.0106 Etan+MTX 60,434 85 6.9173 0.0113 Infl+MTX 47,044 67 6.3844 0.0105 Base 16,472 16 5.3751 0.0097 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 30,845 69 0.9158 0.0105 Etan – Base 43,739 82 1.4374 0.0111 Ad+M – Base 30,964 69 1.0429 0.0105 Et+M – Base 43,962 83 1.5422 0.0111 In+M – Base 30,572 66 1.0094 0.0104 Ad+M – Adal 120 93 0.1271 0.0110 Et+M – Etan 223 110 0.1048 0.0119 Etan – Adal 12,894 103 0.5216 0.0114 Et+M – Ad+M 12,997 103 0.4994 0.0115 Ad+M – In+M 393 92 0.0335 0.0109 Et+M – In+M 13,390 101 0.5329 0.0115 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 33,700 32,900 to 34,500 Etan – Base 30,400 30,000 to 30,900 Ad+M – Base 29,700 29,100 to 30,300 Et+M – Base 28,500 28,100 to 28,900 In+M – Base 30,300 29,700 to 30,900 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan 2,120 Dominates to 4,280 Etan – Adal 24,700 23,600 to 25,900 Et+M – Ad+M 26,000 24,800 to 27,400 Ad+M – In+M 11,700 6,500 to 59,200 Et+M – In+M 25,100 24,000 to 26,300 TABLE 144 Variation 13: TNF inhibitors third (late RA values) (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 46,475 98 5.6051 0.0147 Etan 59,709 120 6.3171 0.0156 Adal+MTX 47,066 99 5.8852 0.0147 Etan+MTX 59,706 120 6.2940 0.0157 Infl+MTX 46,456 94 5.6372 0.0148 Base 16,473 23 5.3979 0.0138 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 30,002 96 0.2073 0.0142 Etan – Base 43,236 116 0.9192 0.0151 Ad+M – Base 30,593 97 0.4873 0.0143 Et+M – Base 43,232 116 0.8961 0.0153 In+M – Base 29,983 92 0.2393 0.0142 Ad+M – Adal 591 130 0.2801 0.0143 Etan – Et+M 3 155 0.0231 0.0160 Etan – Adal 13,234 143 0.7119 0.0151 Et+M – Ad+M 12,639 144 0.4088 0.0154 Ad+M – In+M 610 128 0.2480 0.0145 Et+M – In+M 13,249 142 0.6568 0.0154 continued
TABLE 144 Variation 13: TNF inhibitors third (late RA values) (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 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 145,000 127,000 to 168,000 Etan – Base 47,000 45,500 to 48,700 Ad+M – Base 62,800 59,300 to 66,700 Et+M – Base 48,200 46,600 to 50,000 In+M – Base 125,000 112,000 to 142,000 Ad+M – Adal 2,110 1,160 to 3,060 Etan – Et+M Comparison is inconclusive Etan – Adal 18,600 17,700 to 19,500 Et+M – Ad+M 30,900 28,700 to 33,600 Ad+M – In+M 2,460 1,390 to 3,530 Et+M – In+M 20,200 19,200 to 21,300 TABLE 145 Variation 13: TNF inhibitors last (20,000 patients) Option Cost (£) QSE QALYs QSE Adal 35,094 216 1.8291 0.0217 Etan 48,150 264 2.9608 0.0267 Adal+MTX 35,380 219 2.1258 0.0225 Etan+MTX 48,416 265 2.9210 0.0270 Infl+MTX 35,066 210 1.8709 0.0224 Base 2,848 11 1.0178 0.0181 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 32,246 215 0.8113 0.0158 Etan – Base 45,302 262 1.9431 0.0230 Ad+M – Base 32,531 217 1.1080 0.0172 Et+M – Base 45,567 262 1.9032 0.0232 In+M – Base 32,217 208 0.8532 0.0168 Ad+M – Adal 285 298 0.2967 0.0204 Et+M – Etan 266 352 –0.0399 0.0299 Etan – Adal 13,056 325 1.1318 0.0253 Et+M – Ad+M 13,036 327 0.7952 0.0263 Ad+M – In+M 314 292 0.2548 0.0213 Et+M – In+M 13,350 321 1.0500 0.0260 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 39,700 38,200 to 41,400 Etan – Base 23,300 22,700 to 23,900 Ad+M – Base 29,400 28,400 to 30,400 Et+M – Base 23,900 23,300 to 24,600 In+M – Base 37,800 36,300 to 39,400 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 11,500 10,800 to 12,300 Et+M – Ad+M 16,400 15,100 to 17,900 Ad+M – In+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 12,700 11,900 to 13,700 213
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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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