A systematic review of the effectiveness of adalimumab

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218 Appendix 10 TABLE 152 Variation 15: TNF inhibitors third (late RA values) (40,000 patients) Option Cost (£) QSE QALYs QSE Adal 46,642 154 5.6138 0.0232 Etan 59,704 188 6.3308 0.0246 Adal+MTX 46,901 155 5.9263 0.0232 Etan+MTX 60,076 189 6.3199 0.0249 Infl+MTX 46,267 148 5.6352 0.0233 Base 16,492 36 5.4140 0.0217 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 30,151 151 0.1998 0.0223 Etan – Base 43,213 182 0.9169 0.0237 Ad+M – Base 30,409 151 0.5123 0.0226 Et+M – Base 43,584 183 0.9059 0.0240 In+M – Base 29,775 145 0.2212 0.0225 Ad+M – Adal 259 206 0.3125 0.0228 Et+M – Etan 372 244 –0.0110 0.0253 Etan – Adal 13,062 226 0.7171 0.0237 Et+M – Ad+M 13,175 228 0.3936 0.0242 Ad+M – In+M 634 201 0.2911 0.0230 Et+M – In+M 13,809 223 0.6847 0.0242 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 151,000 123,000 to 194,000 Etan – Base 47,100 44,800 to 49,700 Ad+M – Base 59,400 54,500 to 65,200 Et+M – Base 48,100 45,700 to 50,800 In+M – Base 135,000 112,000 to 169,000 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 18,200 17,000 to 19,700 Et+M – Ad+M 33,500 29,700 to 38,400 Ad+M – In+M 2,180 758 to 3,600 Et+M – In+M 20,200 18,700 to 21,900 TABLE 153 Variation 15: TNF inhibitors last (40,000 patients) Option Cost (£) QSE QALYs QSE Adal 35,348 154 1.8651 0.0157 Etan 48,690 186 2.9900 0.0189 Adal+MTX 35,388 154 2.1386 0.0159 Etan+MTX 49,012 187 2.9827 0.0193 Infl+MTX 35,511 149 1.9051 0.0160 Base 2,865 8 1.0327 0.0130 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 32,482 153 0.8324 0.0115 Etan – Base 45,825 184 1.9573 0.0161 Ad+M – Base 32,523 152 1.1058 0.0122 Et+M – Base 46,147 185 1.9500 0.0167 In+M – Base 32,646 147 0.8724 0.0120 Ad+M – Adal 41 211 0.2734 0.0147 Et+M – Etan 322 247 –0.0073 0.0212 Etan – Adal 13,342 230 1.1249 0.0179 Et+M – Ad+M 13,624 232 0.8442 0.0189 In+M – Ad+M 123 207 –0.2334 0.0151 Et+M – In+M 13,501 227 1.0776 0.0187 continued
TABLE 153 Variation 15: TNF inhibitors last (40,000 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 39,000 37,900 to 40,200 Etan – Base 23,400 23,000 to 23,800 Ad+M – Base 29,400 28,700 to 30,100 Et+M – Base 23,700 23,200 to 24,100 In+M – Base 37,400 36,400 to 38,500 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 11,900 11,300 to 12,400 Et+M – Ad+M 16,100 15,300 to 17,100 In+M – Ad+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 12,500 12,000 to 13,200 Variation 16 In this variation, short-term quitters on conventional DMARDs were reduced by 50%. TABLE 154 Variation 16: TNF inhibitors first (200,000 patients) Option Cost (£) QSE QALYs QSE Adal 49,314 72 8.9243 0.0119 Etan 63,789 88 9.2683 0.0124 Adal+MTX 49,359 73 8.5292 0.0113 Etan+MTX 63,870 89 8.9366 0.0120 Infl+MTX 48,774 70 8.3809 0.0114 Base 15,059 15 8.2830 0.0112 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 34,255 71 0.6412 0.0119 Etan – Base 48,730 85 0.9853 0.0122 Ad+M – Base 34,300 72 0.2461 0.0116 Et+M – Base 48,811 86 0.6535 0.0121 In+M – Base 33,715 69 0.0978 0.0116 Ad+M – Adal 46 98 –0.3951 0.0120 Et+M – Etan 81 117 –0.3317 0.0126 Etan – Adal 14,475 107 0.3441 0.0124 Et+M – Ad+M 14,511 109 0.4074 0.0121 Ad+M – In+M 585 97 0.1483 0.0117 Et+M – In+M 15,096 107 0.5557 0.0121 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 53,400 51,500 to 55,500 Etan – Base 49,500 48,200 to 50,700 Ad+M – Base 139,000 127,000 to 154,000 Et+M – Base 74,700 72,000 to 77,600 In+M – Base 345,000 278,000 to 452,000 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 42,100 39,200 to 45,400 Et+M – Ad+M 35,600 33,600 to 37,900 Ad+M – In+M 3,940 2,500 to 5,390 Et+M – In+M 27,200 26,000 to 28,500 219
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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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TABLE 80 Kobelt et al., 2003 162 (c
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A systematic review of the effectiveness of adalimumab

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