A systematic review of the effectiveness of adalimumab

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216 Appendix 10 TABLE 149 Variation 14: TNF inhibitors last (20,000 patients) Option Cost (£) QSE QALYs QSE Adal 37,360 214 1.8689 0.0219 Etan 49,845 262 2.9910 0.0267 Adal+MTX 37,334 215 2.1633 0.0223 Etan+MTX 50,136 263 2.9875 0.0272 Infl+MTX 37,314 208 1.9216 0.0226 Base 2,869 11 1.0236 0.0183 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 34,491 213 0.8453 0.0160 Etan – Base 46,976 259 1.9675 0.0229 Ad+M – Base 34,465 213 1.1398 0.0171 Et+M – Base 47,267 260 1.9639 0.0234 In+M – Base 34,445 206 0.8980 0.0170 Adal – Ad+M 26 292 –0.2945 0.0204 Et+M – Etan 291 348 –0.0035 0.0299 Etan – Adal 12,485 322 1.1222 0.0253 Et+M – Ad+M 12,802 323 0.8242 0.0263 Ad+M – In+M 20 289 0.2417 0.0213 Et+M – In+M 12,822 316 1.0659 0.0262 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 40,800 39,200 to 42,500 Etan – Base 23,900 23,300 to 24,500 Ad+M – Base 30,200 29,300 to 31,300 Et+M – Base 24,100 23,500 to 24,700 In+M – Base 38,400 36,900 to 39,900 Adal – Ad+M Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 11,100 10,400 to 11,900 Et+M – Ad+M 15,500 14,400 to 16,900 Ad+M – In+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 12,000 11,200 to 12,900 Variation 15 In this variation, short-term quitters on TNF inhibitors were increased by 50% compared to <strong>the</strong> base case. TABLE 150 Variation 15: TNF inhibitors first (400,000 patients) Option Cost (£) QSE QALYs QSE Adal 48,439 51 8.9461 0.0084 Etan 63,188 62 9.2858 0.0087 Adal+MTX 48,589 52 8.4953 0.0080 Etan+MTX 63,452 63 8.9254 0.0085 Infl+MTX 47,964 50 8.3522 0.0080 Base 15,293 10 8.2891 0.0079 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 33,146 50 0.6569 0.0085 Etan – Base 47,895 61 0.9967 0.0087 Ad+M – Base 33,296 51 0.2062 0.0083 Et+M – Base 48,159 61 0.6362 0.0086 In+M – Base 32,670 49 0.0631 0.0083 Ad+M – Adal 150 70 –0.4507 0.0085 Et+M – Etan 264 83 –0.3604 0.0090 continued
TABLE 150 Variation 15: TNF inhibitors first (400,000 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 14,749 77 0.3398 0.0088 Et+M – Ad+M 14,862 78 0.4301 0.0086 Ad+M – In+M 626 69 0.1431 0.0083 Et+M – In+M 15,488 76 0.5732 0.0086 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 50,500 49,200 to 51,800 Etan – Base 48,100 47,200 to 48,900 Ad+M – Base 161,000 149,000 to 176,000 Et+M – Base 75,700 73,700 to 77,800 In+M – Base 518,000 410,000 to 703,000 Ad+M – Adal Adal alone dominates Adal+MTX Et+M – Etan Etan alone dominates Etan+MTX Etan – Adal 43,400 41,200 to 45,800 Et+M – Ad+M 34,600 33,200 to 36,100 Ad+M – In+M 4,370 3,280 to 5,460 Et+M – In+M 27,000 26,200 to 27,900 TABLE 151 Variation 15: TNF inhibitors third (early RA values) (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 47,414 99 6.3210 0.0149 Etan 60,282 119 6.8437 0.0159 Adal+MTX 47,500 99 6.4689 0.0149 Etan+MTX 60,789 120 6.9720 0.0159 Infl+MTX 47,191 95 6.4248 0.0148 Base 16,484 23 5.4070 0.0137 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 30,930 97 0.9140 0.0148 Etan – Base 43,798 116 1.4367 0.0156 Ad+M – Base 31,017 97 1.0619 0.0149 Et+M – Base 44,305 117 1.5650 0.0158 In+M – Base 30,708 93 1.0178 0.0147 Ad+M – Adal 86 132 0.1479 0.0155 Et+M – Etan 507 155 0.1283 0.0169 Etan – Adal 12,868 145 0.5228 0.0162 Et+M – Ad+M 13,288 145 0.5031 0.0163 Ad+M – In+M 309 129 0.0441 0.0115 Et+M – In+M 13,597 143 0.5472 0.0162 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 33,800 32,800 to 35,000 Etan – Base 30,500 29,800 to 31,200 Ad+M – Base 29,200 28,400 to 30,100 Et+M – Base 28,300 27,700 to 28,900 In+M – Base 30,200 29,300 to 31,100 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan 3,950 1,310 to 6,590 Etan – Adal 24,600 23,100 to 26,300 Et+M – Ad+M 26,400 24,700 to 28,400 Ad+M – In+M 7,010 Dominates to 14,700 Et+M – In+M 24,900 23,400 to 26,500 217
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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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TABLE 79 Wong et al., 2002 161 © Q
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A systematic review of the effectiveness of adalimumab

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