Avelumab's Effect on Reducing Cancer Mortality Among Adult Patients With Locally Advanced or Metastatic Urothelial Carcinoma

OBJECTIVES: Platinum-based chemotherapy (CT) and immune checkpoint inhibitors (ICIs) are treatment options for patients with locally advanced or metastatic urothelial carcinoma (mUC). While most ICIs are employed as first- or second-line treatments, avelumab is used for maintenance therapy following platinum-based CT.

METHODS: A mathematical model was developed to describe treatment duration and survival of patients with mUC across four scenarios: No use of ICIs (Scenario 1); Use of pembrolizumab, nivolumab or atezolizumab for a subset of eligible patients (Scenario 2: current practice); Maintenance therapy with avelumab after platinum-based CT in all eligible patients (Scenario 3); Use of avelumab for a subset of eligible patients instead of other ICIs (budget-neutral scenario 4). The model estimated budget expenditure and the number of lives saved when transitioning all eligible patients from Scenario 1 to Scenario 2, from Scenario 2 to Scenario 3, and from Scenario 1 to the budget-neutral scenario 4 over a three-year horizon.

RESULTS: Annually, 4,182 patients in Russia can start treatment with the considered alternatives. Compared to Scenario 1, the current use of ICIs in a portion of these patients (Scenario 2) saves 553 lives over three years, at a cost of 77.3 thousand US$ per life saved. Transitioning to avelumab therapy in Scenario 3 could result in 2,506 additional lives saved, with the cost per life saved amounting to 70.5 thousand US$. Using avelumab instead of other ICIs within the same budget (Scenario 4) could save 1,602 lives with no additional costs, achieving the lowest cost per life saved at 26.7 thousand US$.

CONCLUSIONS: Maintenance therapy with avelumab for patients with mUC may significantly reduce cancer-related mortality in Russia, even without incurring additional costs.