A systematic review of the effectiveness of adalimumab

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214 Appendix 10 Variation 14 In this variation, the probability of quitting TNF inhibitors in the short term was reduced by 50%. TABLE 146 Variation 14: TNF inhibitors first (1,000,000 patients) Option Cost (£) QSE QALYs QSE Adal 50,542 32 8.9468 0.0053 Etan 64,418 39 9.2912 0.0055 Adal+MTX 50,660 33 8.5290 0.0051 Etan+MTX 64,608 39 8.9364 0.0054 Infl+MTX 49,980 31 8.3593 0.0051 Base 15,336 7 8.3177 0.0050 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 35,206 32 0.6291 0.0054 Etan – Base 49,083 38 0.9735 0.0055 Ad+M – Base 35,325 32 0.2112 0.0052 Et+M – Base 49,273 38 0.6187 0.0054 In+M – Base 34,645 30 0.0416 0.0052 Ad+M – Adal 118 44 –0.4178 0.0054 Et+M – Etan 190 52 –0.3547 0.0057 Etan – Adal 13,876 48 0.3444 0.0056 Et+M – Ad+M 13,948 48 0.4075 0.0055 Ad+M – In+M 680 43 0.1697 0.0052 Et+M – In+M 14,628 47 0.5771 0.0055 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 56,000 55,000 to 56,900 Etan – Base 50,400 49,900 to 51,000 Ad+M – Base 167,000 159,000 to 176,000 Et+M – Base 79,600 78,300 to 81,100 In+M – Base 833,000 666,000 to 1,110,000 Ad+M – Adal Adal alone dominates Adal+MTX Et+M – Etan Etan alone dominates Etan+MTX Etan – Adal 40,300 39,000 to 41,700 Et+M – Ad+M 34,200 33,300 to 35,200 Ad+M – In+M 4,010 3,440 to 4,570 Et+M – In+M 25,300 24,800 to 25,900 TABLE 147 Variation 14: TNF inhibitors third (early RA values) (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 49,271 98 6.3330 0.0150 Etan 61,438 119 6.8631 0.0159 Adal+MTX 49,332 98 6.4770 0.0149 Etan+MTX 61,790 119 6.9684 0.0160 Infl+MTX 49,095 95 6.4474 0.0149 Base 16,462 23 5.4046 0.0138 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 32,809 96 0.9284 0.0148 Etan – Base 44,977 115 1.4585 0.0157 Ad+M – Base 32,871 96 1.0724 0.0148 Et+M – Base 45,329 116 1.5638 0.0157 In+M – Base 32,633 92 1.0429 0.0148 Ad+M – Adal 62 130 0.1440 0.0154 Et+M – Etan 352 154 0.1053 0.0169 Etan – Adal 12,168 143 0.5301 0.0162 continued
TABLE 147 Variation 14: TNF inhibitors third (early RA values) (100,000 patients) (cont’d) © Queen’s Printer and Controller of HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 Et+M – Ad+M 12,458 143 0.4914 0.0162 Ad+M – In+M 238 127 0.0296 0.0154 Et+M – In+M 12,695 141 0.5209 0.0161 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 35,300 34,200 to 36,500 Etan – Base 30,800 30,200 to 31,500 Ad+M – Base 30,700 29,800 to 31,500 Et+M – Base 29,000 28,400 to 29,600 In+M – Base 31,300 30,400 to 32,200 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan 3,340 234 to 6,450 Etan – Adal 23,000 21,500 to 24,600 Et+M – Ad+M 25,400 23,700 to 27,300 Ad+M – In+M Comparison is inconclusive Et+M – In+M 24,400 22,900 to 26,100 TABLE 148 Variation 14: TNF inhibitors third (late RA values) (40,000 patients) Option Cost (£) QSE QALYs QSE Adal 48,510 154 5.6096 0.0234 Etan 60,764 187 6.3362 0.0247 Adal+MTX 48,682 154 5.8713 0.0232 Etan+MTX 61,084 187 6.2842 0.0248 Infl+MTX 48,029 148 5.6453 0.0235 Base 16,478 36 5.3700 0.0217 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 32,032 150 0.2396 0.0223 Etan – Base 44,286 181 0.9662 0.0237 Ad+M – Base 32,204 150 0.5013 0.0225 Et+M – Base 44,606 181 0.9141 0.0239 In+M – Base 31,551 144 0.2753 0.0224 Ad+M – Adal 172 202 0.2617 0.0227 Etan – Et+M 319 240 –0.0521 0.0252 Etan – Adal 12,255 224 0.7266 0.0239 Et+M – Ad+M 12,402 223 0.4128 0.0242 Ad+M – In+M 653 198 0.2260 0.0228 Et+M – In+M 13,054 220 0.6389 0.0241 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 134,000 113,000 to 164,000 Etan – Base 45,800 43,700 to 48,200 Ad+M – Base 64,200 58,900 to 70,600 Et+M – Base 48,800 46,300 to 51,500 In+M – Base 115,000 98,600 to 137,000 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Etan – Et+M Etan+MTX more effective than Etan alone; diff. cost not significant Etan – Adal 16,900 15,700 to 18,200 Et+M – Ad+M 30,000 26,800 to 34,200 Ad+M – In+M 2,890 1,040 to 4,740 Et+M – In+M 20,400 18,900 to 22,300 215
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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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Appendix 8 © Queen’s Printer and
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Page 181 and 182: TABLE 80 Kobelt et al., 2003 162 (c
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Page 185 and 186: TABLE 83 Kobelt et al., 2004 163 (c
Page 187 and 188: TABLE 85 Bansback et al., 2005 166
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Page 229: TABLE 144 Variation 13: TNF inhibit
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A systematic review of the effectiveness of adalimumab

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