The ongoing appraisal for adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, abatacept and tocilizumab for the treatment of rheumatoid arthritis (review of TA guidance 130, 186, 224, 234 and part review of TA guidance 225 and 247) seems to have encountered a problem. From the NICE website:
“The current scheduled second Committee meeting on 7 January 2014 for this appraisal topic has been cancelled. This is to allow NICE to work towards releasing an executable model for consultee and commentator comment and an external review of the evidence for disease progression in rheumatoid arthritis prior to the Committee meeting to finalise its preliminary recommendations.”
An ACD has yet to appear, so here’s our summary of the 736 page ERG report in the meantime………..
Three populations were considered; Population 1, adults with severe active RA not previously treated with conventional DMARDs; Population 2, adults with severe active RA that have been previously treated with conventional only; and Population 3 adults with moderate to severe active RA that have been previously treated with conventional DMARDs only.
The typical incremental cost per QALY of biologic DMARDs compared with a conventional DMARD alone strategy is typically over £50,000 per QALY when used in Populations 2 and 3. The ICER is greater than £400,000 per QALY in Population 1. Several parameters are responsible for an increase in the ICERs seen in previous appraisals. The largest effect is produced by the estimated deterioration in Health Assessment Questionnaire whilst on conventional DMARDs; if the values from previous NICE appraisals are used instead of the new estimates, the incremental cost per QALY falls to below £35,000 in some scenarios for biologic DMARDs.
The full ERG team were Matt Stevenson, Rachel Archer, Jon Tosh, Emma Simpson, Emma Everson-Hock, John Stevens, Allan Wailoo, Monica Hernandez, Suzy Paisley, Kath Williams, David Scott (King’s College Hospital NHS Foundation Trust) and Adam Young (West Hertfordshire Hospitals NHS Trust).