A systematic review of the effectiveness of adalimumab
A systematic review of the effectiveness of adalimumab A systematic review of the effectiveness of adalimumab
220 Appendix 10 TABLE 155 Variation 16: TNF inhibitors third (early RA values) (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 48,077 98 6.1839 0.0148 Etan 60,569 119 6.6881 0.0158 Adal+MTX 48,004 98 6.3123 0.0147 Etan+MTX 60,729 119 6.8202 0.0158 Infl+MTX 47,742 94 6.2718 0.0147 Base 16,282 23 5.2523 0.0135 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 31,796 96 0.9317 0.0144 Etan – Base 44,287 115 1.4358 0.0153 Ad+M – Base 31,723 95 1.0600 0.0145 Et+M – Base 44,447 115 1.5679 0.0155 In+M – Base 31,461 92 1.0195 0.0144 Adal – Ad+M 73 130 –0.1283 0.0152 Et+M – Etan 160 154 0.1321 0.0167 Etan – Adal 12,491 143 0.5041 0.0159 Et+M – Ad+M 12,725 143 0.5079 0.0161 Ad+M – In+M 262 127 0.0405 0.0151 Et+M – In+M 12,987 141 0.5484 0.0160 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 34,100 33,100 to 35,200 Etan – Base 30,800 30,200 to 31,500 Ad+M – Base 29,900 29,100 to 30,800 Et+M – Base 28,300 27,800 to 28,900 In+M – Base 30,900 30,000 to 31,800 Adal – Ad+M Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Etan+MTX more effective than Etan alone; diff. cost not significant Etan – Adal 24,800 23,200 to 26,600 Et+M – Ad+M 25,100 23,500 to 26,900 Ad+M – In+M 6,460 Dominates to 14,400 Et+M – In+M 23,700 22,300 to 25,300 TABLE 156 Variation 16: TNF inhibitors third (late RA values) (40,000 patients) Option Cost (£) QSE QALYs QSE Adal 47,168 153 5.4548 0.0229 Etan 59,981 187 6.1606 0.0243 Adal+MTX 47,513 154 5.7821 0.0230 Etan+MTX 59,811 187 6.1612 0.0248 Infl+MTX 47,179 148 5.5014 0.0232 Base 16,305 36 5.2680 0.0213 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 30,862 149 0.1869 0.0218 Etan – Base 43,676 181 0.8926 0.0233 Ad+M – Base 31,207 150 0.5141 0.0221 Et+M – Base 43,505 181 0.8932 0.0238 In+M – Base 30,874 144 0.2334 0.0221 Ad+M – Adal 345 203 0.3273 0.0223 Etan – Et+M 171 241 –0.0007 0.0252 Etan – Adal 12,814 224 0.7057 0.0234 Et+M – Ad+M 12,298 224 0.3791 0.0239 Ad+M – In+M 333 199 0.2807 0.0224 Et+M – In+M 12,631 219 0.6598 0.0240 continued
TABLE 156 Variation 16: TNF inhibitors third (late RA values) (40,000 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 165,000 134,000 to 215,000 Etan – Base 48,900 46,500 to 51,700 Ad+M – Base 60,700 55,900 to 66,400 Et+M – Base 48,700 46,200 to 51,500 In+M – Base 132,000 111,000 to 163,000 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 18,200 16,900 to 19,600 Et+M – Ad+M 32,400 28,700 to 37,300 Ad+M – In+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 19,100 17,700 to 20,800 TABLE 157 Variation 16: TNF inhibitors last (20,000 patients) Option Cost (£) QSE QALYs QSE Adal 35,614 212 1.6384 0.0211 Etan 48,151 258 2.7369 0.0258 Adal+MTX 36,030 215 1.9330 0.0216 Etan+MTX 48,536 260 2.7245 0.0264 Infl+MTX 35,659 205 1.6827 0.0218 Base 2,746 11 0.8031 0.0171 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 32,867 210 0.8353 0.0156 Etan – Base 45,405 255 1.9338 0.0225 Ad+M – Base 33,284 213 1.1299 0.0169 Et+M – Base 45,790 257 1.9214 0.0231 In+M – Base 32,913 203 0.8796 0.0163 Ad+M – Adal 417 290 0.2946 0.0204 Et+M – Etan 385 339 –0.0124 0.0297 Etan – Adal 12,538 319 1.0985 0.0248 Et+M – Ad+M 12,506 320 0.7915 0.0262 Ad+M – In+M 371 286 0.2503 0.0210 Et+M – In+M 12,877 315 1.0417 0.0261 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 39,300 37,800 to 41,000 Etan – Base 23,500 22,900 to 24,100 Ad+M – Base 29,500 28,500 to 30,400 Et+M – Base 23,800 23,200 to 24,500 In+M – Base 37,400 36,000 to 38,900 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 11,400 10,600 to 12,200 Et+M – Ad+M 15,800 14,600 to 17,200 Ad+M – In+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 12,400 11,600 to 13,300 221
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220<br />
Appendix 10<br />
TABLE 155 Variation 16: TNF inhibitors third (early RA values) (100,000 patients)<br />
Option Cost (£) QSE QALYs QSE<br />
Adal 48,077 98 6.1839 0.0148<br />
Etan 60,569 119 6.6881 0.0158<br />
Adal+MTX 48,004 98 6.3123 0.0147<br />
Etan+MTX 60,729 119 6.8202 0.0158<br />
Infl+MTX 47,742 94 6.2718 0.0147<br />
Base 16,282 23 5.2523 0.0135<br />
Comparison Diff. cost (£) QSE Diff. QALY QSE<br />
Adal – Base 31,796 96 0.9317 0.0144<br />
Etan – Base 44,287 115 1.4358 0.0153<br />
Ad+M – Base 31,723 95 1.0600 0.0145<br />
Et+M – Base 44,447 115 1.5679 0.0155<br />
In+M – Base 31,461 92 1.0195 0.0144<br />
Adal – Ad+M 73 130 –0.1283 0.0152<br />
Et+M – Etan 160 154 0.1321 0.0167<br />
Etan – Adal 12,491 143 0.5041 0.0159<br />
Et+M – Ad+M 12,725 143 0.5079 0.0161<br />
Ad+M – In+M 262 127 0.0405 0.0151<br />
Et+M – In+M 12,987 141 0.5484 0.0160<br />
Comparison ICER (£ per QALY) Quasi-CI<br />
Adal – Base 34,100 33,100 to 35,200<br />
Etan – Base 30,800 30,200 to 31,500<br />
Ad+M – Base 29,900 29,100 to 30,800<br />
Et+M – Base 28,300 27,800 to 28,900<br />
In+M – Base 30,900 30,000 to 31,800<br />
Adal – Ad+M Adal+MTX more effective than Adal alone; diff. cost not significant<br />
Et+M – Etan Etan+MTX more effective than Etan alone; diff. cost not significant<br />
Etan – Adal 24,800 23,200 to 26,600<br />
Et+M – Ad+M 25,100 23,500 to 26,900<br />
Ad+M – In+M 6,460 Dominates to 14,400<br />
Et+M – In+M 23,700 22,300 to 25,300<br />
TABLE 156 Variation 16: TNF inhibitors third (late RA values) (40,000 patients)<br />
Option Cost (£) QSE QALYs QSE<br />
Adal 47,168 153 5.4548 0.0229<br />
Etan 59,981 187 6.1606 0.0243<br />
Adal+MTX 47,513 154 5.7821 0.0230<br />
Etan+MTX 59,811 187 6.1612 0.0248<br />
Infl+MTX 47,179 148 5.5014 0.0232<br />
Base 16,305 36 5.2680 0.0213<br />
Comparison Diff. cost (£) QSE Diff. QALY QSE<br />
Adal – Base 30,862 149 0.1869 0.0218<br />
Etan – Base 43,676 181 0.8926 0.0233<br />
Ad+M – Base 31,207 150 0.5141 0.0221<br />
Et+M – Base 43,505 181 0.8932 0.0238<br />
In+M – Base 30,874 144 0.2334 0.0221<br />
Ad+M – Adal 345 203 0.3273 0.0223<br />
Etan – Et+M 171 241 –0.0007 0.0252<br />
Etan – Adal 12,814 224 0.7057 0.0234<br />
Et+M – Ad+M 12,298 224 0.3791 0.0239<br />
Ad+M – In+M 333 199 0.2807 0.0224<br />
Et+M – In+M 12,631 219 0.6598 0.0240<br />
continued
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