THE IMPACT OF PERIOPERATIVE IMMUNE CHECKPOINT INHIBITORS ON THE ECONOMIC BURDEN OF BLADDER CANCER IN CANADA
Author(s)
Kimberly Guinan, MSc1, Catherine Royer, B.Sc. Act., ASA1, Karine Mathurin, MSc1, Nikkita Dutta, MSc2, Julia Shen, MSc2, Jean Lachaine, PhD1.
1PeriPharm Inc., Montreal, QC, Canada, 2AstraZeneca Canada, Mississauga, ON, Canada.
1PeriPharm Inc., Montreal, QC, Canada, 2AstraZeneca Canada, Mississauga, ON, Canada.
OBJECTIVES: Durvalumab is the first perioperative immune checkpoint inhibitor for resectable muscle invasive bladder cancer (MIBC), administered in combination with neoadjuvant gemcitabine and cisplatin (neo-GC), followed by adjuvant durvalumab monotherapy (periop-DUR). In the NIAGARA trial, periop-DUR demonstrated a statistically significant benefit in overall survival and event-free survival over neo-GC. No published Canadian health care resource utilization (HCRU) analyses currently evaluate periop-DUR against Canadian standard of care. This study estimates HCRU and costs associated with treatments for resectable MIBC from healthcare and societal perspectives in Canada.
METHODS: A cost calculator built as a lifetime decision-tree model from a Canadian publicly funded healthcare perspective comparing periop-DUR with neo-GC was developed. Adjuvant nivolumab was excluded given population and timing differences and the absence of comparison with neo-GC. Costs included treatment acquisition and administration, surgery, monitoring, adverse events (AEs), subsequent treatments and palliative care, and are reported in 2025 Canadian dollars. A societal perspective was assessed in a scenario analysis, assessing patient and caregiver productivity loss along with travel-related costs. Efficacy inputs were informed by the NIAGARA trial, with the first event assessed at 36-months and a cure point at 5-years. Model inputs were validated with Canadian clinical experts to reflect current practice.
RESULTS: Relative to neo-GC, periop-DUR reduced downstream HCRU costs by $488 per patient in AE management, $26,989 in subsequent therapy and $9,753 in palliative care, driven by improved clinical outcomes and an increased proportion of patients achieving a higher cure rate. Total per-patient healthcare costs were estimated at $145,380 for neo-GC and $251,613 for periop-DUR. Findings were directionally consistent in the societal perspective scenario.
CONCLUSIONS: From a Canadian healthcare perspective, perioperative durvalumab in early curative-intent disease enables more effective treatment while optimizing resource use, supporting their potential to deliver meaningful clinical and HCRU value in resectable MIBC.
METHODS: A cost calculator built as a lifetime decision-tree model from a Canadian publicly funded healthcare perspective comparing periop-DUR with neo-GC was developed. Adjuvant nivolumab was excluded given population and timing differences and the absence of comparison with neo-GC. Costs included treatment acquisition and administration, surgery, monitoring, adverse events (AEs), subsequent treatments and palliative care, and are reported in 2025 Canadian dollars. A societal perspective was assessed in a scenario analysis, assessing patient and caregiver productivity loss along with travel-related costs. Efficacy inputs were informed by the NIAGARA trial, with the first event assessed at 36-months and a cure point at 5-years. Model inputs were validated with Canadian clinical experts to reflect current practice.
RESULTS: Relative to neo-GC, periop-DUR reduced downstream HCRU costs by $488 per patient in AE management, $26,989 in subsequent therapy and $9,753 in palliative care, driven by improved clinical outcomes and an increased proportion of patients achieving a higher cure rate. Total per-patient healthcare costs were estimated at $145,380 for neo-GC and $251,613 for periop-DUR. Findings were directionally consistent in the societal perspective scenario.
CONCLUSIONS: From a Canadian healthcare perspective, perioperative durvalumab in early curative-intent disease enables more effective treatment while optimizing resource use, supporting their potential to deliver meaningful clinical and HCRU value in resectable MIBC.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE48
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Oncology