Journal Article

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

Kearney, Mairead, Plessala, Ingrid, Lévy, Pierre, Xiao, Ying, Lambert, Prisca, Ravaud, Alain, Chang, Jane, Roiz, Julie, Cawston, Hélène, Loriot, Yohann, Solbes, Marie-Noelle, Porte, Fanny, Thiery-Vuillemin, Antoine, Granghaud, Anna, Morel, Aya

2024

Overview

This study evaluated the cost-effectiveness of avelumab first-line (1L) maintenance therapy plus best supportive care (BSC) versus BSC alone for adults with locally advanced or metastatic urothelial carcinoma (la/mUC) that had not progressed following platinum-based chemotherapy in France. A three-state partitioned survival model was developed to assess the lifetime costs and effects of avelumab plus BSC versus BSC alone. Data from the phase 3 JAVELIN Bladder 100 trial (NCT02603432) were used to inform estimates of clinical and utility values considering a 10-year time horizon and a weekly cycle length. Cost data were estimated from a collective perspective and included treatment acquisition, administration, follow-up, adverse event-related hospitalization, transport, post-progression, and end-of-life costs. Health outcomes were measured in quality-adjusted life-years (QALYs) and life-years gained. Costs and clinical outcomes were discounted at 2.5% per annum. Incremental cost-effectiveness ratios (ICERs) were used to compare cost-effectiveness and willingness to pay in France. Uncertainty was assessed using a range of sensitivity analyses. Avelumab plus BSC was associated with a gain of 2.49 QALYs and total discounted costs of €136,917; BSC alone was associated with 1.82 QALYs and €39,751. Although avelumab plus BSC was associated with increased acquisition costs compared with BSC alone, offsets of -€20,424 and -€351 were observed for post-progression and end-of-life costs, respectively. The base case analysis ICER was €145,626/QALY. Sensitivity analyses were consistent with the reference case and showed that efficacy parameters (overall survival, time to treatment discontinuation), post-progression time on immunotherapy, and post-progression costs had the largest impact on the ICER. This analysis demonstrated that avelumab plus BSC is associated with a favorable cost-effectiveness profile for patients with la/mUC who are eligible for 1L maintenance therapy in France.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Aged / Antibodies, Monoclonal, Humanized - economics / Antibodies, Monoclonal, Humanized - therapeutic use / Bladder cancer / Cancer / Cancer therapies / Carcinoma / Carcinoma, Transitional Cell - drug therapy / Carcinoma, Transitional Cell - economics / Carcinoma, Transitional Cell - mortality / Carcinoma, Transitional Cell - pathology / Chemotherapy / Cost analysis / Cost assessments / Cost-Benefit Analysis / Creatinine / Drug dosages / Economic analysis / Economics and Finance / Effectiveness / End of life / FDA approval / Female / France / Human health and pathology / Humanities and Social Sciences / Humans / Immunotherapy / Life Sciences / Ligands / Maintenance / Maintenance Chemotherapy - economics / Male / Medical care, Cost of / Metastases / Metastasis / Middle Aged / Monoclonal antibodies / Neoplasm Metastasis / Oncology / Patients / Pharmaceutical industry / Pharmaceutical sciences / Pharmacology / Platinum / Quality-Adjusted Life Years / Santé publique et épidémiologie / Sensitivity analysis / Standard of care / Survival / Targeted cancer therapy / Urinary Bladder Neoplasms - drug therapy / Urinary Bladder Neoplasms - economics / Urinary Bladder Neoplasms - pathology / Urination / Urologic Neoplasms - drug therapy / Urologic Neoplasms - economics / Urologic Neoplasms - mortality / Urologic Neoplasms - pathology / Urology / Urology and Nephrology / Urothelial carcinoma