A systematic review of the effectiveness of adalimumab

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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 <strong>of</strong> 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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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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TABLE 82 Brennan et al., 2004 160
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A systematic review of the effectiveness of adalimumab

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