Abstract
Background
Recently, a clinical trial (NCT02603432) showed that avelumab maintenance treatment,
post first-line chemotherapy, can significantly prolong the overall survival of patients
with advanced urothelial carcinoma (UC), however, the treatment was very expensive.
This study aimed to determine the cost-effectiveness of avelumab maintenance therapy
in advanced or metastatic UC from the US taxpayer perspective.
Methods
Based on the data of the JAVELIN Bladder 100 clinical trial (NCT 02603432), a Markov
multi-state model was constructed to investigate the costs and clinical outcomes of
avelumab maintenance after platinum-based chemotherapy versus best supportive care
(BSC) for advanced or metastatic UC. Parameters of the model came from the 2020 Average
Sales Price Drug Pricing Files and published literature. The main outputs were costs,
life years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness
ratio (ICER). Robustness was tested by deterministic and probabilistic sensitivity
analyses. The analysis was stratified to include both the overall population and a
subset of programmed death-ligand 1 (PD-L1)-positive patients.
Results
Avelumab maintenance therapy was estimated to generate an additional 0.26 QALYs (1.46
vs. 1.20 QALYs) and costs $183,271 ($278,323 vs. $95,052) more compared to BSC alone
in the overall population, yielding an ICER of $699,065/QALY. For the PD-L1-positive
population, avelumab produced a 0.42 increase in QALYs (1.74 vs. 1.32 QALYs) and raised
costs to $223,238 ($320,355 vs. $97,117), resulting in an ICER of $521,850/QALY for
this population. Both ICERs were above the willingness-to-pay (WTP) threshold of $200,000/QALY.
Sensitivity analyses manifested that the model was robust.
Conclusion
From the perspective of the US taxpayer, avelumab maintenance therapy is considered
cost-ineffective for patients with advanced or metastatic UC at a WTP threshold of
$200,000/QALY in the overall population as well as in PD-L1-positive population.
Keywords
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Article info
Publication history
Published online: October 08, 2022
Accepted:
October 2,
2022
Received:
January 26,
2022
Footnotes
Dong Lin and Shaohong Luo contributed equally to this work.
Xiuhua Weng and Xiongwei Xu are all the corresponding authors of the study.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
