TABLE 37Cost-effectiveness of the strategies under different scenarios

ScenarioDescriptionAdalimumabEtanerceptInfliximab
1Base caseEx dom< 20K> 30K
2Rebound in HAQ is small after withdrawal (base case = initial gain)Ex dom< 20K> 30K
3Rapid worsening in HAQ with no treatment (upper 95% of CI)Ex dom< 20K> 30K
4Log-PASI utility function (Abbott151) (base case linear)Ex dom< 20K> 30K
5No correlation between PASI 75 and PsARC (base case = 0.4)Ex dom< 20K> 30K
6RCT results fully generalisable to clinical practice (no adjustment for placebo effect)Ex dom< 20K> 30K
9Exponential HAQ-cost function (Abbott151) (base case linear)Ex dom< 20K> 30K
12Inpatient treatment for uncontrolled psoriasis< 20KDom< 20K
13Cost per 3 month per 1 unit change in HAQ is £183 (US data)42 (base case £103)Ex dom< 20K> 30K
14Change in utility per 1 unit change in HAQ is −0.45 (Wyeth153) (base case −0.29)Ex dom< 20K> 30K
15HAQ improves while on drug (lower 95% of CI) (base case no change)Ex dom< 20K20–30K
16High rate of withdrawal (upper 95% of CI)Ex dom< 20K> 30K
17Low rate of withdrawal (lower 95% of CI)Ex dom< 20K> 30K
18All treatments have the same probability of PsARC response at 3 monthsEx dom< 20K> 30K
19All treatments have the same probability of psoriasis responses (PASI 50, 75 and 90) at 3 monthsEx dom< 20K> 30K
20Cost of drugs as in Wyeth submission153Ex dom< 20K> 30K
22All biologics have the same change in HAQ at 3 months for a PsARC responder< 20K< 20K> 30K
23Three vials of infliximab (base case: four vials)Ex domEx dom< 20K
26Rebound to NH after withdrawal (base case: rebound to initial gain)Ex dom> 30K> 30K
31No costs of psoriasis (base case: UK data)Ex dom< 20K> 30K
32Schering-Plough estimates152 of cost per PASI point without phototherapy152Ex dom< 20K> 30K
33Schering-Plough estimates152 of cost per PASI point with phototherapy152< 20KEx dom< 20K
99The effectiveness of biologic therapy lasts no longer than 10 years, compared with palliative careEx dom20–30K> 30K
35Continue on biologic after 3 months if respond to either PsARC or PASI 75 (base case: PsARC only)Ex dom20–30K> 30K
38Assume that adalimumab and etanercept are equally effective for PsARC response, HAQ change and PASI response< 20K< 20K> 30K

< 20K, mean ICER is < £20,000 per QALY; 20–30K, mean ICER is between £20,000 and £30,000 per QALY; > 30K, , mean ICER is > £30,000 per QALY; Dom, dominated; Ex dom, extended dominated.

From: 4, Assessment of cost-effectiveness evidence

Cover of Etanercept, Infliximab and Adalimumab for the Treatment of Psoriatic Arthritis: A Systematic Review and Economic Evaluation
Etanercept, Infliximab and Adalimumab for the Treatment of Psoriatic Arthritis: A Systematic Review and Economic Evaluation.
Health Technology Assessment, No. 15.10.
Rodgers M, Epstein D, Bojke L, et al.
Southampton (UK): NIHR Journals Library; 2011 Feb.
© 2011, Crown Copyright.

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