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  • 2018 SYCAMORE cost-effectiveness paper ACCEPTED Ophthalmology

    Accepted author manuscript, 924 KB, PDF document

    Embargo ends: 16/10/19

    Licence: CC BY-NC-ND Show licence


  • Dyfrig A. Hughes
  • Giovanna Culeddu
  • Catrin O. Plumpton
  • Eifiona Wood
  • Andrew D. Dick
    Bristol NHS Foundation Trust
  • Ashley P. Jones
    Institute of Translational Medicine, University of Liverpool
  • Andrew McKay
    Institute of Translational Medicine, University of Liverpool
  • Paula R. Williamson
    Institute of Translational Medicine, University of Liverpool
  • Sandrine Compeyrot Lacassagne
    University College London
  • Ben Hardwick
    Institute of Translational Medicine, University of Liverpool
  • Helen Hickey
    Institute of Translational Medicine, University of Liverpool
  • Patricia Woo
    Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology
  • Michael W. Beresford
    Institute of Translational Medicine, University of Liverpool
  • Athimalaipet V. Ramanan
    Bristol NHS Foundation Trust
Purpose: To investigate the cost-effectiveness of adalimumab in combination with methotrexate, compared with methotrexate alone, for the management of uveitis associated with Juvenile Idiopathic Arthritis (JIA-U).
Design: A cost-utility analysis based on a clinical trial and decision analytic model.
Participants: Children and adolescents aged 2 to 18 years with persistently active JIA-U, despite optimized methotrexate treatment for at least 12 weeks.
Methods: The SYCAMORE trial [ISRCTN10065623] of methotrexate (up to 25mg per week) with or without fortnightly administered adalimumab (20mg or 40mg, according to body weight) provided data on resource use (based on patient self-report and electronic records) and health utilities (from the Health Utilities Index questionnaire). Surgical event rates and long-term outcomes were based on data from a 10-year longitudinal cohort. A Markov model was used to extrapolate the effects of treatment based on visual impairment.
Main outcome measures: Medical costs to the National Health Service in the UK, utility of defined health states, quality-adjusted life years (QALY), and incremental cost per QALY.
Results: Adalimumab in combination with methotrexate resulted in additional costs of £39,316 with a 0.30 QALY gain compared with methotrexate alone, resulting in an incremental cost-effectiveness ratio of £129,025 per QALY gained. The probability of cost-effectiveness at a threshold of £30,000 per QALY was less than 1%. Based on a threshold analysis, a price reduction of 84% would be necessary for adalimumab to be cost-effective.
Conclusions: Adalimumab is clinically effective in JIA-U, however its cost-effectiveness is not demonstrated compared with methotrexate alone in the UK setting.


  • Anti-TNF, Juvenile Idiopathic Arthritis, uveitis, Cost-effectiveness, Economic Evaluation
Original languageEnglish
Pages (from-to)415-424
Issue number3
Early online date16 Oct 2018
Publication statusPublished - Mar 2019
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