A systematic review of the effectiveness of adalimumab
A systematic review of the effectiveness of adalimumab A systematic review of the effectiveness of adalimumab
222 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
TABLE 159 Variation 17: TNF inhibitors third (early RA values) (200,000 patients) (cont’d) © Queen’s Printer and Controller of HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 Etan – Adal 12,800 103 0.5579 0.0117 Et+M – Ad+M 12,564 103 0.5100 0.0118 Ad+M – In+M 454 92 0.0279 0.0112 Et+M – In+M 13,017 101 0.5379 0.0117 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 32,500 31,800 to 33,200 Etan – Base 29,100 28,600 to 29,500 Ad+M – Base 28,600 28,000 to 29,100 Et+M – Base 27,300 27,000 to 27,700 In+M – Base 28,900 28,300 to 29,400 Ad+M – Adal 2,330 1,020 to 3,630 Et+M – Etan Etan+MTX more effective than Etan alone; diff. cost not significant Etan – Adal 22,900 22,000 to 24,000 Et+M – Ad+M 24,600 23,500 to 25,900 Ad+M – In+M 16,300 8,560 to 161,000 Et+M – In+M 24,200 23,100 to 25,400 TABLE 160 Variation 17: TNF inhibitors third (late RA values) (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 47,967 98 5.7255 0.0150 Etan 61,045 119 6.4486 0.0158 Adal+MTX 48,371 99 5.9809 0.0149 Etan+MTX 60,953 119 6.4212 0.0160 Infl+MTX 47,619 94 5.7371 0.0150 Base 16,602 23 5.4093 0.0140 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 31,366 96 0.3162 0.0145 Etan – Base 44,444 116 1.0393 0.0154 Ad+M – Base 31,769 97 0.5716 0.0147 Et+M – Base 44,351 116 1.0119 0.0156 In+M – Base 31,017 92 0.3278 0.0146 Ad+M – Adal 404 131 0.2554 0.0148 Etan – Et+M 93 155 0.0274 0.0163 Etan – Adal 13,078 143 0.7231 0.0154 Et+M – Ad+M 12,582 144 0.4402 0.0157 Ad+M – In+M 752 128 0.2438 0.0149 Et+M – In+M 13,334 141 0.6841 0.0157 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 99,200 90,800 to 109,000 Etan – Base 42,800 41,500 to 44,100 Ad+M – Base 55,600 52,800 to 58,600 Et+M – Base 43,800 42,500 to 45,200 In+M – Base 94,600 86,900 to 104,000 Ad+M – Adal 1,580 541 to 2,620 Etan – Et+M Comparison is inconclusive Etan – Adal 18,100 17,300 to 19,000 Et+M – Ad+M 28,600 26,600 to 30,900 Ad+M – In+M 3,090 1,970 to 4,200 Et+M – In+M 19,500 18,600 to 20,500 223
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TABLE 159 Variation 17: TNF inhibitors third (early RA values) (200,000 patients) (cont’d)<br />
© Queen’s Printer and Controller <strong>of</strong> HMSO 2006. All rights reserved.<br />
Health Technology Assessment 2006; Vol. 10: No. 42<br />
Etan – Adal 12,800 103 0.5579 0.0117<br />
Et+M – Ad+M 12,564 103 0.5100 0.0118<br />
Ad+M – In+M 454 92 0.0279 0.0112<br />
Et+M – In+M 13,017 101 0.5379 0.0117<br />
Comparison ICER (£ per QALY) Quasi-CI<br />
Adal – Base 32,500 31,800 to 33,200<br />
Etan – Base 29,100 28,600 to 29,500<br />
Ad+M – Base 28,600 28,000 to 29,100<br />
Et+M – Base 27,300 27,000 to 27,700<br />
In+M – Base 28,900 28,300 to 29,400<br />
Ad+M – Adal 2,330 1,020 to 3,630<br />
Et+M – Etan Etan+MTX more effective than Etan alone; diff. cost not significant<br />
Etan – Adal 22,900 22,000 to 24,000<br />
Et+M – Ad+M 24,600 23,500 to 25,900<br />
Ad+M – In+M 16,300 8,560 to 161,000<br />
Et+M – In+M 24,200 23,100 to 25,400<br />
TABLE 160 Variation 17: TNF inhibitors third (late RA values) (100,000 patients)<br />
Option Cost (£) QSE QALYs QSE<br />
Adal 47,967 98 5.7255 0.0150<br />
Etan 61,045 119 6.4486 0.0158<br />
Adal+MTX 48,371 99 5.9809 0.0149<br />
Etan+MTX 60,953 119 6.4212 0.0160<br />
Infl+MTX 47,619 94 5.7371 0.0150<br />
Base 16,602 23 5.4093 0.0140<br />
Comparison Diff. cost (£) QSE Diff. QALY QSE<br />
Adal – Base 31,366 96 0.3162 0.0145<br />
Etan – Base 44,444 116 1.0393 0.0154<br />
Ad+M – Base 31,769 97 0.5716 0.0147<br />
Et+M – Base 44,351 116 1.0119 0.0156<br />
In+M – Base 31,017 92 0.3278 0.0146<br />
Ad+M – Adal 404 131 0.2554 0.0148<br />
Etan – Et+M 93 155 0.0274 0.0163<br />
Etan – Adal 13,078 143 0.7231 0.0154<br />
Et+M – Ad+M 12,582 144 0.4402 0.0157<br />
Ad+M – In+M 752 128 0.2438 0.0149<br />
Et+M – In+M 13,334 141 0.6841 0.0157<br />
Comparison ICER (£ per QALY) Quasi-CI<br />
Adal – Base 99,200 90,800 to 109,000<br />
Etan – Base 42,800 41,500 to 44,100<br />
Ad+M – Base 55,600 52,800 to 58,600<br />
Et+M – Base 43,800 42,500 to 45,200<br />
In+M – Base 94,600 86,900 to 104,000<br />
Ad+M – Adal 1,580 541 to 2,620<br />
Etan – Et+M Comparison is inconclusive<br />
Etan – Adal 18,100 17,300 to 19,000<br />
Et+M – Ad+M 28,600 26,600 to 30,900<br />
Ad+M – In+M 3,090 1,970 to 4,200<br />
Et+M – In+M 19,500 18,600 to 20,500<br />
223
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