A systematic review of the effectiveness of adalimumab

Summary of review of existing
economic evaluations
A comprehensive search for existing economic
evaluations was undertaken. These were assessed
for quality using the Consensus on Health
Economic Criteria (CHEC) list.
Existing economic evaluations
Ten published economic evaluations and four
unpublished economic evaluations, of which only
three were available electronically, were identified
and reviewed. All were of high quality meeting at
least 15 of the 19 quality assessment criteria. All
but one used a decision-analytic model. Most gave
incremental cost-effectiveness ratios (ICERs) that
suggested that the use of TNF inhibitors was
under the threshold normally considered to be the
limit for cost-effectiveness. Direct comparison of
the ICERs between the studies is not possible
because of their different approaches to
modelling, time-horizons, comparators and
perspective, country of origin, source of
preference weights and effectiveness data used.
Many of the estimates for effectiveness were
derived from single trials, or a subset of trials
rather than a systematic review and meta-analysis
of relevant trial and observational data.
Although most were of high quality, none of them
used all the appropriate parameters, effectiveness
data, perspective and comparators required to
make their results generalisable to the NHS context.
The aim of this section is to assess the costeffectiveness
of adalimumab, etanercept and
infliximab for treating RA from an NHS
perspective.
This section of the report has three components:
● a review of existing economic evaluations of the
use of TNF inhibitors in RA
● a technical commentary on the decision-analytic
models used in the economic analyses reported
in the manufacturers’ submissions to NICE
● a description of the BRAM and the economic
analyses of TNF inhibitors used singly or
sequentially in RA patients, undertaken by the
authors.
Chapter 4
Health economics
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Health Technology Assessment 2006; Vol. 10: No. 42
Systematic review of economic
evaluations
Method
Search strategy
The searches for clinical effectiveness were
amplified to identify existing economic models
and information on costs, cost-effectiveness and
quality of life from the following sources:
● Bibliographic databases
– MEDLINE (Ovid) 1966 to February 2005,
EMBASE (Ovid) 1980 to week 9 2005
– Cochrane Library (NHS EED) 2005 Issue 1
– HEED February 2005
● Internet sites of national economic units
● Internet sites of regulatory authorities, e.g.
FDA, EMEA.
Time and language limits were as for clinical
effectiveness searches. Systematic reviews of
DMARDs were sought to inform the economic
analysis and provide a context for biological TNF
inhibitors. The search strategy was based on the
Aggressive Research Intelligence Facility (ARIF)
search protocol for reviews, which includes the
Cochrane Library, Clinical Evidence, MEDLINE,
Bandolier, health technology assessment databases
and in-house databases. Full details of search
strategies are contained in Appendices 5–7.
Inclusion and exclusion criteria
The review is an update of a previous report. 1
Inclusion and exclusion criteria applied for
economic searches are shown in Table 18.
TABLE 18 Inclusion criteria for the review on cost-effectiveness
Study design Cost–consequence analysis, cost–benefit
analysis, cost-effectiveness analysis,
cost–utility analysis, cost studies (UK
only), quality of life studies
Population People with RA; other forms of arthritis
are excluded
Intervention Etanercept, infliximab or adalimumab
Comparator DMARDs
Outcome Quality of life estimates, cost estimates,
cost-effectiveness
73