A systematic review of the effectiveness of adalimumab

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Health economics
TABLE 24 Summary of methods used in industry economic analyses
Submission Abbott Laboratories Wyeth Schering-Plough
features Adalimumab (Humira ® ) Etanercept (Enbrel ® ) Infliximab (Remicade ® )
Choice of TNF Adalimumab in combination with Six-line drug sequence with Infliximab in combination with
inhibitor MTX etanercept/MTX combination MTX
1st line, 2nd line or 3rd line
Comparator Three-line drug sequence Six-line drug sequence without MTX alone
without use of adalimumab use of etanercept
Patient Patients with RA, average age Patients with RA, average age Two patient groups: (1) active
characteristics 55 years, 77% women, who 53 years, (in line with patients RA despite treatment with
have failed three DMARDs in TEMPO) DMARDs; (2) severe active
including MTX early RA
Form of analysis Cost–utility analysis Cost–utility analysis Cost–utility analysis
Model used Patient-based transition-state Markov model with 6-monthly Markov model with 6-monthly
model with 10,000 patients cycles and 10,000 patients cycles, based on ARAMIS
Time-horizon of Lifetime Lifetime Lifetime
model
Base-case results £17,860 per QALY 1st line: £16,000 per QALY MTX experienced:
2nd line: £20,000 per QALY £6228 per QALY
3rd line: £18,000 per QALY MTX-naïve: £16,766 per QALY
MTX-naïve with high CRP:
£13,000 per QALY
ethical and distributional issues in any of the
included studies.
● All but one economic analysis used a decisionanalytic
model. Published models vary in some
important aspects; for example, the type of
model used, whether switching of therapy is
considered, drug combinations, comparator
therapies, and time-horizon and cycle length.
● One study carried out a cost-effectiveness
analysis using patient-level data on costs and
outcomes from a patient cohort. However,
results for two separate TNF inhibitors were
combined.
● Six studies report costs that include both those
from a healthcare perspective and indirect costs
including losses of productivity; inclusion of
these productivity costs improves the costeffectiveness
of TNF inhibitors.
● One study carried out a cost-effectiveness
analysis, with the remaining nine conducting a
cost–utility analysis. Two studies obtained
preference weights from VAS, considered to be a
less acceptable method for obtaining
preference. The remaining seven studies used
EQ-5D, in some cases using regression analysis
to convert HAQ scores to EQ-5D.
● In model-based analyses, costs and benefits
were modelled over a number of different time-
horizons: 6 months (one study), 1 year (one
study), 5 years (one study), 10 years (two
studies) and lifetime (four studies). However,
there was no association between ICER values
and time-horizon used.
Review of industry costeffectiveness
submissions
A detailed summary of the economic analyses and
models included in the company submissions to
NICE for the appraisal of adalimumab, etanercept
and infliximab carried out in 2005–6 is reported
in this section. All three companies provided an
electronic model.
The methods used in the economic analyses are
presented in Table 24.
Abbott submission (adalimumab)
A patient-based, state-transition model was
developed to assess the cost-effectiveness of
adalimumab in combination with methotrexate
compared with a sequence of traditional DMARDs
in patients with moderate to severe RA. The main
treatment sequences considered are shown in
Table 25. Adalimumab monotherapy and other TNF