A systematic review of the effectiveness of adalimumab

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Appendix 10
Variation 17
In this variation, short-term quitters on conventional DMARDs were increased by 50% compared to the
base case.
TABLE 158 Variation 17: TNF inhibitors first (10,000,000 patients)
Option Cost (£) QSE QALYs QSE
Adal 49,715 10 8.9033 0.0017
Etan 64,017 12 9.2629 0.0018
Adal+MTX 50,012 10 8.4065 0.0016
Etan+MTX 64,298 12 8.8430 0.0017
Infl+MTX 49,330 10 8.2443 0.0016
Base 15,626 2 8.2329 0.0016
Comparison Diff. cost (£) QSE Diff. QALY QSE
Adal – Base 34,088 10 0.6704 0.0017
Etan – Base 48,391 12 1.0300 0.0018
Ad+M – Base 34,386 10 0.1736 0.0017
Et+M – Base 48,672 12 0.6101 0.0018
In+M – Base 33,704 10 0.0114 0.0017
Ad+M – Adal 298 14 –0.4968 0.0017
Et+M – Etan 281 16 –0.4199 0.0018
Etan – Adal 14,302 15 0.3596 0.0018
Et+M – Ad+M 14,286 15 0.4365 0.0018
Ad+M – In+M 683 14 0.1622 0.0017
Et+M – In+M 14,986 15 0.5987 0.0018
Comparison ICER (£ per QALY) Quasi-CI
Adal – Base 50,800 50,600 to 51,100
Etan – Base 47,000 46,800 to 47,100
Ad+M – Base 198,000 194,000 to 202,000
Et+M – Base 79,800 79,300 to 80,200
In+M – Base 2,950,000 2,270,000 to 4,180,000
Ad+M – Adal Adal alone dominates Adal+MTX
Et+M – Etan Etan alone dominates Etan+MTX
Etan – Adal 39,800 39,400 to 40,200
Et+M – Ad+M 32,700 32,500 to 33,000
Ad+M – In+M 4,210 4,020 to 4,400
Et+M – In+M 25,000 24,800 to 25,200
TABLE 159 Variation 17: TNF inhibitors third (early RA values) (200,000 patients)
Option Cost (£) QSE QALYs QSE
Adal 48,713 70 6.4132 0.0107
Etan 61,513 84 6.9711 0.0114
Adal+MTX 49,060 70 6.5622 0.0107
Etan+MTX 61,624 84 7.0722 0.0114
Infl+MTX 48,606 67 6.5343 0.0107
Base 16,575 16 5.4246 0.0099
Comparison Diff. cost (£) QSE Diff. QALY QSE
Adal – Base 32,138 69 0.9886 0.0107
Etan – Base 44,938 82 1.5465 0.0113
Ad+M – Base 32,485 69 1.1376 0.0108
Et+M – Base 45,048 82 1.6476 0.0114
In+M – Base 32,031 66 1.1097 0.0107
Ad+M – Adal 347 94 0.1490 0.0112
Et+M – Etan 110 110 0.1011 0.0121
continued