A systematic review of the effectiveness of adalimumab

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224 Appendix 10 TABLE 161 Variation 17: TNF inhibitors last (40,000 patients) Option Cost (£) QSE QALYs QSE Adal 37,083 155 2.2519 0.0167 Etan 50,402 189 3.3443 0.0198 Adal+MTX 37,492 157 2.5198 0.0170 Etan+MTX 50,589 190 3.3466 0.0201 Infl+MTX 37,150 150 2.2976 0.0171 Base 2,970 8 1.3602 0.0142 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 34,113 154 0.8917 0.0119 Etan – Base 47,431 187 1.9841 0.0165 Ad+M – Base 34,522 156 1.1596 0.0127 Et+M – Base 47,619 188 1.9864 0.0170 In+M – Base 34,180 148 0.9374 0.0125 Ad+M – Adal 409 213 0.2679 0.0150 Et+M – Etan 188 249 0.0024 0.0214 Etan – Adal 13,319 232 1.0924 0.0181 Et+M – Ad+M 13,097 234 0.8269 0.0190 Ad+M – In+M 342 208 0.2221 0.0154 Et+M – In+M 13,439 229 1.0490 0.0189 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 38,300 37,200 to 39,400 Etan – Base 23,900 23,500 to 24,400 Ad+M – Base 29,800 29,100 to 30,500 Et+M – Base 24,000 23,500 to 24,400 In+M – Base 36,500 35,500 to 37,500 Ad+M – Adal Adal+MTX more effective than Adal alone; diff. cost not significant Et+M – Etan Comparison is inconclusive Etan – Adal 12,200 11,600 to 12,800 Et+M – Ad+M 15,800 15,000 to 16,800 Ad+M – In+M Adal+MTX more effective than Infl+MTX; diff. cost not significant Et+M – In+M 12,800 12,200 to 13,500 Variation 18 For the final variation, the use of offset costs was considered to account for joint replacement and hospitalisation. In the absence of an effective method of including this explicitly in the model, a cost of £860 per unit HAQ score was assumed, as used in previous work. 3 TABLE 162 Variation 18: TNF inhibitors first (400,000 patients) Option Cost (£) QSE QALYs QSE Adal 57,939 54 8.9463 0.0084 Etan 71,889 65 9.3025 0.0088 Adal+MTX 58,353 54 8.5201 0.0080 Etan+MTX 72,424 65 8.9313 0.0085 Infl+MTX 57,933 52 8.3555 0.0080 Base 24,395 19 8.3149 0.0079 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 33,543 52 0.6314 0.0085 Etan – Base 47,494 62 0.9876 0.0087 Ad+M – Base 33,958 52 0.2051 0.0083 Et+M – Base 48,028 62 0.6163 0.0086 In+M – Base 33,537 50 0.0405 0.0083 continued
TABLE 162 Variation 18: TNF inhibitors first (400,000 patients) (cont’d) © Queen’s Printer and Controller of HMSO 2006. All rights reserved. Health Technology Assessment 2006; Vol. 10: No. 42 Ad+M – Adal 414 70 –0.4263 0.0085 Et+M – Etan 534 83 –0.3712 0.0090 Etan – Adal 13,950 77 0.3562 0.0088 Et+M – Ad+M 14,071 77 0.4112 0.0087 Ad+M – In+M 420 69 0.1646 0.0083 Et+M – In+M 14,491 76 0.5758 0.0086 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 53,100 51,700 to 54,600 Etan – Base 48,100 47,200 to 49,000 Ad+M – Base 166,000 153,000 to 180,000 Et+M – Base 77,900 75,800 to 80,200 In+M – Base 827,000 587,000 to 1,400,000 Ad+M – Adal Adal alone dominates Adal+MTX Et+M – Etan Etan alone dominates Etan+MTX Etan – Adal 39,200 37,300 to 41,300 Et+M – Ad+M 34,200 32,800 to 35,800 Ad+M – In+M 2,550 1,680 to 3,420 Et+M – In+M 25,200 24,400 to 26,000 TABLE 163 Variation 18: TNF inhibitors third (early RA values) (100,000 patients) Option Cost (£) QSE QALYs QSE Adal 58,107 106 6.3065 0.0149 Etan 70,040 126 6.8371 0.0159 Adal+MTX 58,088 105 6.4506 0.0149 Etan+MTX 70,137 126 6.9344 0.0159 Infl+MTX 57,699 101 6.4264 0.0149 Base 27,448 43 5.3611 0.0137 Comparison Diff. cost (£) QSE Diff. QALY QSE Adal – Base 30,659 101 0.9454 0.0148 Etan – Base 42,592 119 1.4760 0.0156 Ad+M – Base 30,639 100 1.0895 0.0148 Et+M – Base 42,689 119 1.5733 0.0157 In+M – Base 30,250 96 1.0653 0.0147 Adal – Ad+M 20 133 –0.1441 0.0155 Et+M – Etan 96 157 0.0973 0.0168 Etan – Adal 11,933 146 0.5306 0.0162 Et+M – Ad+M 12,049 146 0.4838 0.0163 Ad+M – In+M 389 130 0.0242 0.0155 Et+M – In+M 12,438 144 0.5080 0.0162 Comparison ICER (£ per QALY) Quasi-CI Adal – Base 32,400 31,400 to 33,500 Etan – Base 28,900 28,200 to 29,500 Ad+M – Base 28,100 27,400 to 28,900 Et+M – Base 27,100 26,600 to 27,700 In+M – Base 28,400 27,600 to 29,200 Ad+M – Adal 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 22,500 21,100 to 24,100 Et+M – Ad+M 24,900 23,200 to 26,800 Ad+M – In+M Adal+MTX more costly than Infl+MTX; diff QALY not significant Et+M – In+M 24,500 22,900 to 26,300 225
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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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TABLE 83 Kobelt et al., 2004 163 (c
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TABLE 85 Bansback et al., 2005 166
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A systematic review of the effectiveness of adalimumab

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