Cost-Effectiveness of Avelumab Maintenance Therapy Plus Best Supportive Care vs. Best Supportive Care Alone for Advanced or Metastatic Urothelial Carcinoma

Abstract

ObjectiveAvelumab (MSB0010718C) is a fully human anti-programmed cell death ligand 1(PD-L1) antibody against PD-L1 interactions and enhances immune activation against tumor cells in the meantime. Avelumab has been approved for locally advanced or metastatic urothelial cancer (mUC) after disease progression in several countries. We therefore conducted this study to evaluate the cost-effectiveness of avelumab maintenance therapy for advanced or mUC from the perspective of the United States (US) and China payer.MethodsA Markov simulation model was performed based on clinical trial JAVELIN Bladder 100. Utilities and costs adopted in this analysis were derived from published literature and clinical trials. Incremental cost-effectiveness ratios (ICERs) were calculated to compare the avelumab maintenance therapy group (AVE group) and the best supportive care group (CON group).ResultsThe ICER of the AVE group compared with the CON group were $38,369.50 and $16,150.29 per QALYs in the overall population and in the PD-L1–positive population, respectively. While the ICER of AVE group compared with CON group were $241,610.25 and $100,528.29 per QALYs in the overall population and in the PD-L1–positive population, respectively.ConclusionAvelumab maintenance therapy was a cost-effective first-line treatment compared with BSC in patients with mUC which were not progressed with platinum-based chemotherapy not only in the PD-L1–positive population but also in the overall population based on the current willingness to pay (WTP) of $150,000 in the US. It was not cost-effective both in the overall population and in the PD-L1 positive population at the WTP threshold of $30,447.09 in China.

Cost-effectiveness of avelumab first-line maintenance therapy for adult patients with locally advanced or metastatic urothelial carcinoma in France

“…The ICER value falls within the lower end of the recently published range for the value of a QALY in France of €147,093 to €201,398 [49]. These findings are also consistent with ICERs for other country models for avelumab 1L maintenance therapy plus BSC in patients with mUC in the US [50] and China [51], which ranged between $102,365/QALY and $241,610/QALY. Similar incremental QALYs and LYs were also reported for the United Kingdom, Finland, and Taiwan [52][53][54].…”

Enhancing Therapeutic Efficacy and Safety of Immune Checkpoint Inhibition for Bladder Cancer: A Comparative Analysis of Injectable vs. Intravesical Administration

“…The systemic breakdown of T-cell mediated immune surveillance by ICIs including pembrolizumab, resulting in immune-related adverse events such as pruritis with skin rash or scar covering <10% (Grade 1) to >30% (Grade 3-4) of body surface area, and endocrine toxicity of varying severity presents a significant challenge in the management of BC patients [16,18,[21][22][23][24]. Guidelines from the American Society of Clinical Oncologist recommend monitoring of grade 1 toxicity and suspension of ICIs for most grade 2 toxicities with optional administration of steroids.…”

“…Grade 3 treatment-related adverse events necessitate administration of steroids and/or antibodies targeting cytokines [14]. Grade 4 toxicity, occurring in 10% to 14% of nivolumab treated patients [13,23], requires permanent discontinuation of ICIs. Notably, treatment-related adverse events of grade 3 or higher occurred in 55.9% of enfortumab vedotin-pembrolizumab treated patients [25].…”