TY - JOUR
T1 - Avelumab Maintenance Treatment After First-line Chemotherapy in Advanced Urothelial Carcinoma–A Cost-Effectiveness Analysis
AU - Lin, Dong
AU - Luo, Shaohong
AU - Lin, Shen
AU - Zhong, Lixian
AU - Zhou, Wei
AU - Gu, Dian
AU - Huang, Xiaoting
AU - Chen, Qixin
AU - Xu, Xiongwei
AU - Weng, Xiuhua
N1 - Funding Information:
This work was supported by the Startup Fund for Scientific Research, Fujian Medical University [ 2020QH1061 ], Fujian Provincial Health Technology Project [2021QNB005].
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2023/2
Y1 - 2023/2
N2 - 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.
AB - 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.
KW - Avelumab
KW - Best supportive care
KW - Cost-effectiveness
KW - Maintenance therapy
KW - Urothelial carcinoma
KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
KW - Carcinoma, Transitional Cell/drug therapy
KW - B7-H1 Antigen
KW - Humans
KW - Cost-Benefit Analysis
KW - Cost-Effectiveness Analysis
KW - Urinary Bladder Neoplasms/drug therapy
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U2 - 10.1016/j.clgc.2022.10.001
DO - 10.1016/j.clgc.2022.10.001
M3 - Article
C2 - 36328903
AN - SCOPUS:85141254597
SN - 1558-7673
VL - 21
SP - 8
EP - 15
JO - Clinical Genitourinary Cancer
JF - Clinical Genitourinary Cancer
IS - 1
ER -