PubMed Health. A service of the National Library of Medicine, National Institutes of Health.

Malottki K, Barton P, Tsourapas A, et al. Adalimumab, Etanercept, Infliximab, Rituximab and Abatacept for the Treatment of Rheumatoid Arthritis After the Failure of a Tumour Necrosis Factor Inhibitor: A Systematic Review and Economic Evaluation. Southampton (UK): NIHR Journals Library; 2011 Mar. (Health Technology Assessment, No. 15.14.)

Appendix 14Scenario analyses

The following scenarios were considered in addition to the reference case analysis. The section headings correspond to the abbreviated descriptions used in Chapter 4, Scenario analysis. In each case, any parameters not mentioned in the description of the scenario remain as in the reference case analysis.

Vary time on tumour necrosis factors inhibitors

In this case, the time to withdrawing TNF inhibitors treatments was changed to give the same relative risk as for their use as first biologic agents. The b parameters from Table 80 (for reference case) were changed as follows:

TreatmentReference case b parameter (point estimate)New b parameter (point estimate)
ADA3.2113.413
ETN3.2114.831
IFX3.2112.086

Results were as follows:

TreatmentMean cost95% credible intervalMean QALY95% credible interval
ADA75,90069,80082,2002.92−2.077.92
ETN82,70076,00089,3003.01−1.867.92
IFX67,40060,90073,8002.62−2.547.73
RTX69,40062,60076,2003.10−1.778.01
ABT93,00086,300100,0003.28−1.528.02
DMARDs49,00043,30055,1002.13−3.257.46
ComparisonDiff cost95% credible intervalDiff QALY95% credible interval
ADA–DMARDs26,90025,10028,6000.780.341.28
ETN–DMARDs33,70031,70035,9000.880.381.47
IFX–DMARDs18,40015,10020,7000.490.210.82
RTX–DMARDs20,40017,50023,5000.960.421.60
ABT–DMARDs44,10041,30046,9001.140.511.86
ADA–RTX6,5003,2009,800−0.18−0.470.05
ETN–RTX13,3009,90016,800−0.09−0.380.16
IFX–RTX−2,000−5,9001,600−0.48−0.87−0.16
ABT–RTX23,60019,60027,5000.18−0.090.50
ADA–ABT−17,200−20,300−14,100−0.36−0.72−0.10
ETN–ABT−10,400−13,500−7,100−0.27−0.59−0.03
IFX–ABT−25,600−29,900−22,100−0.65−1.12−0.26
ADA–ETN−6,800−9,400−4,200−0.09−0.320.10
ADA–IFX8,4005,70012,0000.290.070.56
ETN–IFX15,30012,30018,9000.390.140.72

Diff, difference in.

Difference calculated by subtracting the value for the strategy named second from the value for the strategy named first.

ComparisonICER95% credible intervalProportion of cases cost-effective at
£20,000/QALY£30,000/QALY
ADA–DMARDs34,30020,90079,0000.010.31
ETN–DMARDs38,40023,20087,4000.000.18
IFX–DMARDs37,70022,10090,3000.010.20
RTX–DMARDs21,20012,80048,4000.390.84
ABT–DMARDs38,50023,40086,6000.000.17
ADA–RTXRTXNot meaningful0.000.00
ETN–RTXRTXNot meaningful0.000.00
IFX–TX4,100RTX16,0000.010.00
ABT–RTX131,80048,400RTX0.000.00
ADA–ABT47,70023,500177,1000.990.90
ETN–ABT38,90016,300308,5000.940.73
IFX–ABT39,10022,40095,8000.990.82
ADA–ETN72,80020,400ADA0.980.88
ADA–IFX28,70013,900104,8000.160.51
ETN–IFX39,30021,300110,5000.020.20

The proportion of cases cost-effective relates to the strategy given first on each line. ICER in italics means that the strategy named second is more costly and more effective. Where a strategy name is given in place of an ICER, the named strategy dominates its comparator (less costly and more effective).

Same time on all biologics

In this scenario, the distribution of long-term survival time on all biologics was set to the value used for TNF inhibitors in the reference case. The results were as follows:

TreatmentMean cost95% credible intervalMean QALY95% credible interval
ADA74,80068,70081,0002.88−2.137.87
ETN75,10068,80081,4002.81−2.267.84
IFX73,00066,00079,9002.80−2.237.82
RTX63,70057,90069,9002.83−2.157.86
ABT82,00075,70088,6002.97−1.997.85
DMARDs49,00043,30054,9002.13−3.237.46
ComparisonDiff cost95% credible intervalDiff QALY95% credible interval
ADA–DMARDs25,80024,10027,6000.750.331.21
ETN–DMARDs26,10024,40027,9000.680.281.12
IFX–DMARDs24,00019,30026,8000.670.291.12
RTX–DMARDs14,70013,60015,9000.700.301.15
ABT–DMARDs33,00030,80035,4000.840.371.37
ADA–RTX11,1009,20013,1000.05−0.130.25
ETN–RTX11,4009,50013,500−0.02−0.210.15
IFX–RTX9,4004,70012,300−0.03−0.220.14
ABT–RTX18,40015,90020,8000.14−0.050.36
ADA–ABT−7,200−10,000−4,500−0.09−0.310.11
ETN–ABT−6,900−9,800−4,000−0.16−0.400.03
IFX–ABT−9,000−14,100−5,500−0.17−0.400.02
ADA–ETN−300−2,7002,2000.08−0.100.28
ADA–IFX1,800−1,5006,5000.08−0.100.29
ETN–IFX2,100−1,1007,0000.01−0.170.18

Diff, difference in.

Difference calculated by subtracting the value for the strategy named second from the value for the strategy named first.

ComparisonICER95% credible intervalProportion of cases cost-effective at
£20,000/QALY£30,000/QALY
ADA–DMARDs34,40020,90078,4000.010.31
ETN–DMARDs38,70023,30091,7000.010.17
IFX–DMARDs35,90021,20081,1000.020.24
RTX–DMARDs21,10012,60049,1000.410.84
ABT–DMARDs39,50023,80089,7000.000.15
ADA–RTX206,00044,700RTX0.000.00
ETN–RTXRTXNot meaningful0.000.00
IFX–RTXRTXNot meaningful0.000.00
ABT–RTX131,20049,700RTX0.000.00
ADA–ABT84,10022,500ADA0.990.92
ETN–ABT42,70015,900ETN0.920.76
IFX–ABT53,70020,800IFX0.980.88
ADA–ETNADANot meaningful0.820.82
ADA–IFX21,600Not meaningful0.490.59
ETN–IFX351,500Not meaningful0.190.25

The proportion of cases cost-effective relates to the strategy given first on each line. ICER in italics means that the strategy named second is more costly and more effective. Where a strategy name is given in place of an ICER, the named strategy dominates its comparator (less costly and more effective). A 95% credible interval for the ICER is not meaningful in cases where the cost-effectiveness scatter plot is not confined to one half of the plane.

Rituximab cycle time 6 months

In this case, it was assumed that cycles of RTX would be given every 6 months. The assumption was that withdrawal rates per cycle would be maintained from the reference case. The results are as follows:

TreatmentMean cost95% credible intervalMean QALY95% credible interval
ADA74,80068,50081,1002.89−2.167.81
ETN75,10069,00081,5002.80−2.257.80
IFX73,00065,80079,9002.80−2.277.81
RTX74,80067,20082,4002.93−2.067.89
ABT93,00086,400100,1003.28−1.528.05
DMARDs49,00043,40055,0002.13−3.257.46
ComparisonDiff cost95% credible intervalDiff QALY95% credible interval
ADA–DMARDs25,80024,00027,6000.750.331.24
ETN–DMARDs26,10024,30027,9000.670.271.11
IFX–DMARDs24,00019,20026,8000.670.301.12
RTX–DMARDs25,80021,80030,0000.790.331.34
ABT–DMARDs44,00041,30046,8001.150.501.88
ADA–RTX−18−4,5004,500−0.04−0.290.18
ETN–RTX300−4,1004,700−0.12−0.380.09
IFX–RTX−1,800−7,5003,200−0.12−0.380.08
ABT–RTX18,20013,20023,1000.350.070.73
ADA–ABT−18,200−21,300−15,200−0.39−0.78−0.12
ETN–ABT−17,900−21,100−14,700−0.47−0.87−0.18
IFX–ABT−20,000−25,400−16,200−0.48−0.88−0.16
ADA–ETN−300−2,8002,1000.08−0.090.29
ADA–IFX1,800−1,5006,5000.08−0.110.29
ETN–IFX2,100−1,2007,2000.00−0.180.19

Diff, difference in.

Difference calculated by subtracting the value for the strategy named second from the value for the strategy named first.

ComparisonICER95% credible intervalProportion of cases cost-effective at
£20,000/QALY£30,000/QALY
ADA–DMARDs34,30020,60078,9000.020.31
ETN–DMARDs38,90023,40095,2000.000.17
IFX–DMARDs35,90021,50081,7000.020.26
RTX–DMARDs32,60019,90074,3000.030.37
ABT–DMARDs38,40023,30088,8000.000.17
ADA–RTX430Not meaningful0.360.35
ETN–RTXRTXNot meaningful0.120.10
IFX–RTX14,700Not meaningful0.400.28
ABT–RTX51,50025,400229,2000.000.07
ADA–ABT46,30023,400150,6001.000.90
ETN–ABT37,80020,30095,7000.980.77
IFX–ABT42,00022,500117,7000.990.86
ADA–ETNADANot meaningful0.830.84
ADA–IFX21,700Not meaningful0.480.59
ETN–IFX1,325,400Not meaningful0.180.23

The proportion of cases cost-effective relates to the strategy given first on each line. ICER in italics means that the strategy named second is more costly and more effective. Where a strategy name is given in place of an ICER, the named strategy dominates its comparator (less costly and more effective). A 95% credible interval for the ICER is not meaningful in cases where the cost-effectiveness scatter plot is not confined to one half of the plane.

Rituximab cycle time 11.6 months

In this case, it was assumed that cycles of RTX would be given every 11.6 months, which was the observed mean time in the REFLEX extension study (Roche submission, p. 200). The assumption was that withdrawal rates per cycle would be maintained from the reference case. The results were as follows:

TreatmentMean cost95% credible intervalMean QALY95% credible interval
ADA74,80068,60081,2002.89−2.157.84
ETN75,10068,90081,5002.81−2.237.87
IFX73,00066,00080,0002.80−2.307.83
RTX61,70055,80067,9003.25−1.588.11
ABT93,10086,100100,1003.28−1.538.09
DMARDs49,00043,30055,1002.13−3.277.49
ComparisonDiff cost95% credible intervalDiff QALY95% credible interval
ADA–DMARDs25,80024,10027,6000.750.321.24
ETN–DMARDs26,10024,30028,0000.670.291.10
IFX–DMARDs24,00019,30026,8000.670.281.10
RTX–DMARDs12,70011,00014,5001.110.491.81
ABT–DMARDs44,00041,30046,8001.150.521.89
ADA–RTX13,10010,80015,500−0.36−0.74−0.07
ETN–RTX13,40010,90015,700−0.44−0.84−0.14
IFX–RTX11,3006,60014,600−0.44−0.85−0.14
ABT–RTX31,30028,20034,5000.04−0.270.33
ADA–ABT−18,300−21,400−15,200−0.39−0.76−0.11
ETN–ABT−17,900−21,100−14,600−0.48−0.89−0.17
IFX–ABT−20,000−25,400−16,100−0.48−0.89−0.17
ADA–ETN−300−2,7002,1000.08−0.090.28
ADA–IFX1,800−1,6006,3000.09−0.090.29
ETN–IFX2,100−1,4006,9000.00−0.180.20

Diff, difference.

Difference calculated by subtracting the value for the strategy named second from the value for the strategy named first.

ComparisonICER95% credible intervalProportion of cases cost-effective at
£20,000/QALY£30,000/QALY
ADA–DMARDs34,20020,80079,9000.020.32
ETN–DMARDs38,80023,30090,5000.000.17
IFX–DMARDs35,90021,40084,8000.010.25
RTX–DMARDs11,4006,80025,6000.920.98
ABT–DMARDs38,40023,30085,2000.000.17
ADA–RTXRTXNot meaningful0.000.00
ETN–RTXRTXNot meaningful0.000.00
IFX–RTXRTXNot meaningful0.000.00
ABT–RTX861,10095,700RTX0.000.00
ADA–ABT46,40023,600150,4001.000.90
ETN–ABT37,80020,100103,8000.980.77
IFX–ABT41,80022,600120,5000.990.85
ADA–ETNADANot meaningful0.830.84
ADA–IFX20,700Not meaningful0.510.60
ETN–IFX591,000Not meaningful0.180.24

The proportion of cases cost-effective relates to the strategy given first on each line. ICER in italics means that the strategy named second is more costly and more effective. Where a strategy name is given in place of an ICER, the named strategy dominates its comparator (less costly and more effective). A 95% credible interval for the ICER is not meaningful in cases where the cost-effectiveness scatter plot is not confined to one half of the plane.

Poor late disease-modifying antirheumatic drugs (additional analysis)

In this scenario, the efficacy of conventional DMARDs taken after biologic therapy was reduced. HAQ multipliers were inferred from the Abbott and Roche industry submissions, and the lower of these figures (0.085) was taken. Preserving a + b = 1.22 from the BRAM reference case for LEF gave a = 0.104, b = 1.116. These values were then used for all conventional DMARDs. The results were as follows:

TreatmentMean cost95% credible intervalMean QALY95% credible interval
ADA76,40069,60083,1002.30−3.027.59
ETN76,60070,00083,3002.23−3.067.55
IFX74,60067,10081,8002.22−3.127.51
RTX70,70063,80078,0002.61−2.587.72
ABT94,40087,300101,8002.76−2.337.81
DMARDs51,00044,90057,3001.40−4.387.15
ComparisonDiff cost95% credible intervalDiff QALY95% credible interval
ADA–DMARDs25,40023,70027,2000.900.411.47
ETN–DMARDs25,60023,90027,4000.820.361.33
IFX–DMARDs23,60019,00026,4000.820.361.35
RTX–DMARDs19,70016,90022,4001.210.531.95
ABT–DMARDs43,40040,70046,2001.350.622.17
ADA–RTX5,7002,5008,800−0.30−0.66−0.03
ETN–RTX6,0002,8009,100−0.38−0.77−0.08
IFX–RTX3,900−1,1007,800−0.39−0.77−0.09
ABT–RTX23,70019,90027,5000.15−0.140.48
ADA–ABT−18,100−21,300−15,000−0.45−0.83−0.17
ETN–ABT−17,800−21,000−14,600−0.53−0.96−0.21
IFX–ABT−19,800−25,100−16,000−0.54−0.94−0.20
ADA–ETN−300−2,6002,1000.08−0.100.28
ADA–IFX1,800−1,5006,5000.09−0.090.29
ETN–IFX2,000−1,3007,0000.01−0.170.20

Diff, difference in.

Difference calculated by subtracting the value for the strategy named second from the value for the strategy named first.

ComparisonICER95% credible intervalProportion of cases cost-effective at
£20,000/QALY£30,000/QALY
ADA–DMARDs28,10017,20062,3000.100.57
ETN–DMARDs31,10019,20070,4000.040.43
IFX–DMARDs28,80017,20063,4000.080.54
RTX–DMARDs16,30010,10036,1000.730.94
ABT–DMARDs32,10020,00071,6000.020.39
ADA–RTXRTXNot meaningful0.000.00
ETN–RTXRTXNot meaningful0.000.00
IFX–RTXRTXNot meaningful0.000.00
ABT–RTX158,60051,500RTX0.000.00
ADA–ABT40,10021,400106,2000.990.82
ETN–ABT33,50018,40081,4000.950.67
IFX–ABT36,90020,50095,8000.980.76
ADA–ETNADANot meaningful0.830.84
ADA–IFX20,600Not meaningful0.500.61
ETN–IFX316,000Not meaningful0.170.23

The proportion of cases cost-effective relates to the strategy given first on each line. ICER in italics means that the strategy named second is more costly and more effective. Where a strategy name is given in place of an ICER, the named strategy dominates its comparator (less costly and more effective). A 95% credible interval for the ICER is not meaningful in cases where the cost-effectiveness scatter plot is not confined to one half of the plane.

Health Assessment Questionnaire change on biologics

In this scenario, a deterioration of 0.03/year in HAQ was assumed on biologic treatments. This was modelled as a mean time between 0.125-unit increases of 4 years. For each treatment separately, this figure was given a normal distribution with a SD of 0.4 years. The results were as follows:

TreatmentMean cost95% credible intervalMean QALY95% credible interval
ADA75,50069,20081,9002.53−2.567.75
ETN75,80069,50082,2002.44−2.697.74
IFX73,70066,50080,7002.45−2.717.73
RTX70,40063,60077,5002.56−2.507.81
ABT93,90086,900101,2002.80−2.177.91
DMARDs49,10043,50054,7002.09−3.177.50
ComparisonDiff cost95% credible intervalDiff QALY95% credible interval
ADA–DMARDs26,40024,60028,4000.430.160.78
ETN–DMARDs26,70024,80028,7000.350.120.64
IFX–DMARDs24,60020,30027,3000.360.120.66
RTX–DMARDs21,30018,20024,4000.460.150.85
ABT–DMARDs44,80042,00047,7000.710.291.22
ADA–RTX5,1001,6008,500−0.03−0.300.20
ETN–RTX5,4002,0008,700−0.11−0.410.11
IFX–RTX3,300−2,0007,400−0.11−0.390.12
ABT–RTX23,50019,60027,4000.24−0.030.61
ADA–ABT−18,400−21,400−15,300−0.28−0.59−0.02
ETN–ABT−18,100−21,100−15,000−0.36−0.72−0.09
IFX–ABT−20,100−25,000−16,300−0.35−0.72−0.08
ADA–ETN−300−2,7002,1000.08−0.110.32
ADA–IFX1,800−1,5006,3000.07−0.120.29
ETN–IFX2,100−1,3006,700−0.01−0.210.18

Diff, difference in.

Difference calculated by subtracting the value for the strategy named second from the value for the strategy named first.

ComparisonICER95% credible intervalProportion of cases cost-effective at
£20,000/QALY£30,000/QALY
ADA–DMARDs61,30033,600168,6000.000.01
ETN–DMARDs76,30042,500228,2000.000.00
IFX–DMARDs68,90036,200200,0000.000.00
RTX–DMARDs46,00024,600134,4000.000.09
ABT–DMARDs63,30036,700151,7000.000.00
ADA–RTXRTXNot meaningful0.020.06
ETN–RTXRTXNot meaningful0.000.01
IFX–RTXRTXNot meaningful0.050.05
ABT–RTX96,40038,900RTX0.000.00
ADA–ABT66,50029,400718,0001.000.97
ETN–ABT50,60024,300205,8000.990.91
IFX–ABT57,60027,400250,5001.000.96
ADA–ETNADANot meaningful0.780.80
ADA–IFX24,300Not meaningful0.460.55
ETN–IFXIFXNot meaningful0.210.26

The proportion of cases cost-effective relates to the strategy given first on each line. ICER in italics means that the strategy named second is more costly and more effective. Where a strategy name is given in place of an ICER, the named strategy dominates its comparator (less costly and more effective). A 95% credible interval for the ICER is not meaningful in cases where the cost-effectiveness scatter plot is not confined to one half of the plane.

Adverse event costs included

Additional annual costs based on the Bristol-Myers Squibb LTD submission as follows:

TreatmentAdditional cost (£)
ADA117.82
ETN224.87
IFX162.02
RTX273.51
ABT110.16

When these were included, the results were as follows:

TreatmentMean cost95% credible intervalMean QALY95% credible interval
ADA75,10069,20081,4002.89−2.127.87
ETN75,70069,40082,2002.80−2.217.84
IFX73,50066,50080,3002.80−2.247.82
RTX70,70063,80077,7003.10−1.787.95
ABT93,50086,600100,6003.28−1.468.05
DMARDs49,00043,30054,9002.13−3.277.46
ComparisonDiff cost95% credible intervalDiff QALY95% credible interval
ADA–DMARDs26,10024,50027,9000.750.331.23
ETN–DMARDs26,80024,90028,7000.670.301.10
IFX–DMARDs24,50019,80027,3000.670.291.12
RTX–DMARDs21,70018,60024,7000.960.411.61
ABT–DMARDs44,50041,70047,2001.150.521.88
ADA–RTX4,5001,2008,000−0.21−0.520.03
ETN–RTX5,1001,6008,700−0.29−0.63−0.04
IFX–RTX2,800−2,5007,000−0.30−0.62−0.05
ABT–RTX22,80018,80026,8000.18−0.100.50
ADA–ABT−18,300−21,500−15,300−0.39−0.77−0.12
ETN–ABT−17,700−21,100−14,300−0.47−0.88−0.17
IFX–ABT−20,000−25,200−16,100−0.48−0.88−0.17
ADA–ETN−600−3,2001,8000.08−0.090.29
ADA–IFX1,600−1,6006,4000.09−0.100.29
ETN–IFX2,200−1,1007,1000.00−0.170.19

Diff, difference in.

Difference calculated by subtracting the value for the strategy named second from the value for the strategy named first.

ComparisonICER95% credible intervalProportion of cases cost-effective at
£20,000/QALY£30,000/QALY
ADA–DMARDs34,70021,20080,2000.010.29
ETN–DMARDs39,90024,20091,4000.000.14
IFX–DMARDs36,80021,70083,7000.010.22
RTX–DMARDs22,50013,70052,8000.320.80
ABT–DMARDs38,80023,30085,6000.000.17
ADA–RTXRTXNot meaningful0.000.00
ETN–RTXRTXNot meaningful0.000.00
IFX–RTXRTXNot meaningful0.000.00
ABT–RTX126,10046300RTX0.000.00
ADA–ABT46,70023,200153,0000.990.90
ETN–ABT37,40019,800101,1000.970.76
IFX–ABT41,70021,900113,3000.990.84
ADA–ETNADANot meaningful0.870.87
ADA–IFX19,000Not meaningful0.530.63
ETN–IFX502,600Not meaningful0.170.22

The proportion of cases cost-effective relates to the strategy given first on each line. ICER in italics means that the strategy named second is more costly and more effective. Where a strategy name is given in place of an ICER, the named strategy dominates its comparator (less costly and more effective). A 95% credible interval for the ICER is not meaningful in cases where the cost-effectiveness scatter plot is not confined to one half of the plane.

No offset costs (additional analysis)

In this case the ‘offset costs’ representing the estimates of joint replacement and hospitalisation costs were removed. The results were as follows:

TreatmentMean cost95% credible intervalMean QALY95% credible interval
ADA47,20044,50049,8002.89−2.127.87
ETN47,20044,40050,0002.80−2.217.84
IFX45,10040,10048,7002.80−2.247.82
RTX42,10038,20046,1003.10−1.787.95
ABT66,40062,50070,4003.28−1.468.05
DMARDs19,40017,90020,9002.13−3.277.46
ComparisonDiff cost95% credible intervalDiff QALY95% credible interval
ADA–DMARDs27,80026,00029,6000.750.331.23
ETN–DMARDs27,80025,80029,8000.670.301.10
IFX–DMARDs25,70021,00028,5000.670.291.12
RTX–DMARDs22,70019,50026,0000.960.411.61
ABT–DMARDs47,00044,00050,1001.150.521.88
ADA–RTX5,0001,6008,500−0.21−0.520.03
ETN–RTX5,1001,5008,800−0.29−0.63−0.04
IFX–RTX3,000−2,4007,100−0.30−0.62−0.05
ABT–RTX24,30020,20028,4000.18−0.100.50
ADA–ABT−19,200−22,400−16,200−0.39−0.77−0.12
ETN–ABT−19,200−22,500−16,000−0.47−0.88−0.17
IFX–ABT−21,300−26,500−17,400−0.48−0.88−0.17
ADA–ETN−33−2,4002,4000.08−0.090.29
ADA–IFX2,000−1,2006,7000.09−0.100.29
ETN–IFX2,100−1,3006,9000.00−0.170.19

Diff, difference in.

Difference calculated by subtracting the value for the strategy named second from the value for the strategy named first.

ComparisonICER95% credible intervalProportion of cases cost-effective at
£20,000/QALY£30,000/QALY
ADA–DMARDs36,90022,80084,2000.010.22
ETN–DMARDs41,40025,40095,1000.000.11
IFX–DMARDs38,60023,10089,6000.010.17
RTX–DMARDs23,60014,60055,3000.270.76
ABT–DMARDs41,00024,90090,7000.000.11
ADA–RTXRTXNot meaningful0.000.00
ETN–RTXRTXNot meaningful0.000.00
IFX–RTXRTXNot meaningful0.000.00
ABT–RTX134,10050,100RTX0.000.00
ADA–ABT49,00025,100153,2001.000.92
ETN–ABT40,50022,100109,5000.990.83
IFX–ABT44,40024,000118,0001.000.89
ADA–ETNADANot meaningful0.830.84
ADA–IFX23,500Not meaningful0.460.59
ETN–IFX460,000Not meaningful0.170.23

The proportion of cases cost-effective relates to the strategy given first on each line. ICER in italics means that the strategy named second is more costly and more effective. Where a strategy name is given in place of an ICER, the named strategy dominates its comparator (less costly and more effective). A 95% credible interval for the ICER is not meaningful in cases where the cost-effectiveness scatter plot is not confined to one half of the plane.

Extra cost for palliation (additional analysis)

In this scenario, the cost for Pall was increased to the cost of methotrexate, including monitoring. This involved a start-up cost of £421.03 and an annual usage cost of £995.78. The results were as follows:

TreatmentMean cost95% credible intervalMean QALY95% credible interval
ADA76,80070,50083,5002.89−2.127.87
ETN77,10070,30084,0002.80−2.217.84
IFX75,00067,80082,2002.80−2.247.82
RTX71,10064,10078,3003.10−1.787.95
ABT94,80087,700102,3003.28−1.468.05
DMARDs51,70045,50058,3002.13−3.277.46
ComparisonDiff cost95% credible intervalDiff QALY95% credible interval
ADA–DMARDs25,10023,40026,8000.750.331.23
ETN–DMARDs25,40023,60027,2000.670.301.10
IFX–DMARDs23,40018,90026,1000.670.291.12
RTX–DMARDs19,40016,60022,2000.960.411.61
ABT–DMARDs43,10040,40045,7001.150.521.88
ADA–RTX5,7002,6008,900−0.21−0.520.03
ETN–RTX6,0002,8009,300−0.29−0.63−0.04
IFX–RTX4,000−1,1007,800−0.30−0.62−0.05
ABT–RTX23,70019,90027,4000.18−0.100.50
ADA–ABT−18,000−21,000−15,000−0.39−0.77−0.12
ETN–ABT−17,700−20,900−14,400−0.47−0.88−0.17
IFX–ABT−19,700−24,700−16,100−0.48−0.88−0.17
ADA–ETN−300−2,7002,0000.08−0.090.29
ADA–IFX1,700−1,4006,3000.09−0.100.29
ETN–IFX2,000−1,2006,7000.00−0.170.19

Diff, difference in.

Difference calculated by subtracting the value for the strategy named second from the value for the strategy named first.

ComparisonICER95% credible intervalProportion of cases cost-effective at
£20,000/QALY£30,000/QALY
ADA–DMARDs33,40020,40076,6000.020.34
ETN–DMARDs37,80022,90086,8000.010.20
IFX–DMARDs35,00020,60079,6000.020.28
RTX–DMARDs20,10012,10047,4000.460.86
ABT–DMARDs37,60022,60083,0000.010.19
ADA–RTXRTXNot meaningful0.000.00
ETN–RTXRTXNot meaningful0.000.00
IFX–RTXRTXNot meaningful0.000.00
ABT–RTX131,00047,800RTX0.000.00
ADA–ABT45,80022,800150,0000.990.89
ETN–ABT37,30019,800100,8000.970.76
IFX–ABT41,20021,700112,8000.990.83
ADA–ETNADANot meaningful0.840.84
ADA–IFX20,300Not meaningful0.500.61
ETN–IFX452,000Not meaningful0.190.25

The proportion of cases cost-effective relates to the strategy given first on each line. ICER in italics means that the strategy named second is more costly and more effective. Where a strategy name is given in place of an ICER, the named strategy dominates its comparator (less costly and more effective). A 95% credible interval for the ICER is not meaningful in cases where the cost-effectiveness scatter plot is not confined to one half of the plane.

No negative quality of life scores

In this case, all QoL scores that were calculated as negative using the equation converting HAQ to QoL were replaced by zero. The results were as follows:

TreatmentMean cost95% credible intervalMean QALY95% credible interval
ADA74,80068,80081,0003.801.687.87
ETN75,10068,70081,5003.731.647.84
IFX73,00066,10079,7003.731.667.82
RTX69,40062,70076,4003.941.777.95
ABT93,00086,200100,1004.111.978.05
DMARDs49,00043,30054,9003.271.327.46
ComparisonDiff cost95% credible intervalDiff QALY95% credible interval
ADA–DMARDs25,80024,10027,5000.530.290.73
ETN–DMARDs26,10024,20027,9000.460.250.66
IFX–DMARDs24,00019,50026,8000.460.240.66
RTX–DMARDs20,40017,50023,2000.670.350.95
ABT–DMARDs44,00041,30046,7000.830.501.12
ADA–RTX5,4002,2008,700−0.13−0.360.07
ETN–RTX5,7002,4009,100−0.20−0.430.00
IFX–RTX3,600−1,6007,600−0.20−0.430.00
ABT–RTX23,60019,80027,4000.17−0.080.42
ADA–ABT−18,200−21,300−15,200−0.30−0.54−0.08
ETN–ABT−18,000−21,200−14,600−0.37−0.61−0.15
IFX–ABT−20,000−25,100−16,200−0.37−0.60−0.15
ADA–ETN−300−2,8002,1000.07−0.080.23
ADA–IFX1,800−1,4006,5000.07−0.100.23
ETN–IFX2,000−1,2006,8000.00−0.150.15

Diff, difference in.

Difference calculated by subtracting the value for the strategy named second from the value for the strategy named first.

ComparisonICER95% credible intervalProportion of cases cost-effective at
£20,000/QALY£30,000/QALY
ADA–DMARDs48,60035,30087,1000.000.00
ETN–DMARDs56,50039,100102,7000.000.00
IFX–DMARDs52,10035,10097,5000.000.00
RTX–DMARDs30,70021,70057,3000.010.48
ABT–DMARDs52,80039,10089,1000.000.00
ADA–RTXRTXNot meaningful0.000.00
ETN–RTXRTXNot meaningful0.000.00
IFX–RTXRTXNot meaningful0.000.00
ABT–RTX140,70058,000RTX0.000.00
ADA–ABT60,30033,200216,9001.000.99
ETN–ABT48,30029,100115,0001.000.97
IFX–ABT53,70031,700129,1001.000.99
ADA–ETNADANot meaningful0.820.84
ADA–IFX25,300Not meaningful0.460.57
ETN–IFX7,430,000Not meaningful0.180.22

The proportion of cases cost-effective relates to the strategy given first on each line. ICER in italics means that the strategy named second is more costly and more effective. Where a strategy name is given in place of an ICER, the named strategy dominates its comparator (less costly and more effective). A 95% credible interval for the ICER is not meaningful in cases where the cost-effectiveness scatter plot is not confined to one half of the plane.

Linear equation Health Assessment Questionnaire to quality of life

In this scenario, the linear equation QoL = 0.862 – 0.327HAQ was used as in previous versions of the BRAM. For the probabilistic analysis, the coefficients were sampled from normal distributions with SDs 0.034 and 0.0201 respectively.174 The results were as follows:

TreatmentMean cost95% credible intervalMean QALY95% credible interval
ADA74,80068,70080,9003.031.664.35
ETN75,10068,90081,6002.961.594.28
IFX73,00066,00079,8002.951.604.28
RTX69,40062,70076,0003.221.884.55
ABT93,00086,30099,6003.402.054.71
DMARDs49,00043,30054,9002.360.973.72
ComparisonDiff cost95% credible intervalDiff QALY95% credible interval
ADA–DMARDs25,80024,10027,6000.670.510.84
ETN–DMARDs26,10024,30028,0000.600.440.76
IFX–DMARDs24,10019,60026,8000.590.440.76
RTX–DMARDs20,40017,80023,3000.860.631.12
ABT–DMARDs44,00041,40046,6001.040.811.29
ADA–RTX5,4002,0008,600−0.19−0.430.04
ETN–RTX5,7002,6009,000−0.26−0.50−0.04
IFX–RTX3,700−1,5007,600−0.27−0.53−0.04
ABT–RTX23,70019,70027,4000.18−0.100.44
ADA–ABT−18,200−21,300−15,100−0.37−0.61−0.15
ETN–ABT−17,900−21,100−14,800−0.44−0.67−0.23
IFX–ABT−20,000−25,200−16,200−0.45−0.70−0.22
ADA–ETN−300−2,8002,0000.07−0.100.25
ADA–IFX1,800−1,4006,4000.08−0.110.26
ETN–IFX2,100−1,1006,7000.00−0.170.17

Diff, difference in.

Difference calculated by subtracting the value for the strategy named second from the value for the strategy named first.

ComparisonICER95% credible intervalProportion of cases cost-effective at
£20,000/QALY£30,000/QALY
ADA–DMARDs38,60030,30051,0000.000.02
ETN–DMARDs43,80034,60057,9000.000.00
IFX–DMARDs40,60030,70054,1000.000.02
RTX–DMARDs23,70018,70031,1000.080.96
ABT–DMARDs42,30034,10054,1000.000.00
ADA–RTXRTXNot meaningful0.000.00
ETN–RTXRTXNot meaningful0.000.00
IFX–RTXRTXNot meaningful0.000.00
ABT–RTX130,90054,400RTX0.000.00
ADA–ABT49,10029,300120,0001.000.97
ETN–ABT40,30026,10077,5001.000.90
IFX–ABT44,60027,90092,4001.000.95
ADA–ETNADANot meaningful0.810.82
ADA–IFX23,100Not meaningful0.480.57
ETN–IFX667,000Not meaningful0.190.25

The proportion of cases cost-effective relates to the strategy given first on each line. ICER in italics means that the strategy named second is more costly and more effective. Where a strategy name is given in place of an ICER, the named strategy dominates its comparator (less costly and more effective). A 95% credible interval for the ICER is not meaningful in cases where the cost-effectiveness scatter plot is not confined to one half of the plane.

© 2011, Crown Copyright.

Included under terms of UK Non-commercial Government License.

Cover of Adalimumab, Etanercept, Infliximab, Rituximab and Abatacept for the Treatment of Rheumatoid Arthritis After the Failure of a Tumour Necrosis Factor Inhibitor: A Systematic Review and Economic Evaluation
Adalimumab, Etanercept, Infliximab, Rituximab and Abatacept for the Treatment of Rheumatoid Arthritis After the Failure of a Tumour Necrosis Factor Inhibitor: A Systematic Review and Economic Evaluation.
Health Technology Assessment, No. 15.14.
Malottki K, Barton P, Tsourapas A, et al.
Southampton (UK): NIHR Journals Library; 2011 Mar.

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