COST OF CARE AND BUDGET IMPACT OF FIRST-LINE (1L) TREATMENTS IN PATIENTS WITH LOCALLY ADVANCED OR METASTATIC UROTHELIAL CARCINOMA (LA/MUC) FROM THE MEXICAN PUBLIC PAYER PERSPECTIVE
Author(s)
Paola Jaramillo, MSc1, Pieralessandro Lasalvia, MD1, Manuel Magallanes, MD2, Samuel Rivera, MD3, Margarita FUENTES LOPEZ, MBA4, Veronica Hernández Orellana, MD5, Diana Tellez, MPH, PhD, MD5, JULIANA RESTREPO, MBA6.
1NeuroEconomix, Bogotá, Colombia, 2Hospital Ángeles Universidad, Mexico City, Mexico, Mexico City, Mexico, 3Centro Médico ABC, Mexico City, Mexico, Mexico City, Mexico, 4Merck Biopharma Distribution S.A. de C.V., Naucalpan de Juarez, Mexico, an affiliate of Merck KGaA, Darmstadt, Germany, Naucalpan de Juarez, Mexico, 5Merck S.A., Panamá, Panamá, an affiliate of Merck KGaA, Darmstadt, Germany, Panamá City, Panama, 6Merck S.A., Bogotá, Colombia, an affiliate of Merck KGaA, Darmstadt, Germany, Bogotá, Colombia.
1NeuroEconomix, Bogotá, Colombia, 2Hospital Ángeles Universidad, Mexico City, Mexico, Mexico City, Mexico, 3Centro Médico ABC, Mexico City, Mexico, Mexico City, Mexico, 4Merck Biopharma Distribution S.A. de C.V., Naucalpan de Juarez, Mexico, an affiliate of Merck KGaA, Darmstadt, Germany, Naucalpan de Juarez, Mexico, 5Merck S.A., Panamá, Panamá, an affiliate of Merck KGaA, Darmstadt, Germany, Panamá City, Panama, 6Merck S.A., Bogotá, Colombia, an affiliate of Merck KGaA, Darmstadt, Germany, Bogotá, Colombia.
OBJECTIVES: Newer agents for la/mUC have demonstrated efficacy in clinical trials, but the economic impact of including these in routine care is uncertain. This study aimed to estimate the direct medical costs associated with the first year of treatment and modeled the 5-year budget impact analysis (BIA) of approved 1L therapies for la/mUC in Mexico from the national payer perspective.
METHODS: The evaluated 1L treatment options were enfortumab vedotin + pembrolizumab (EV+PEM), platinum-based chemotherapy (CT) followed by avelumab 1L maintenance + best supportive care (BSC), CT+BSC, and nivolumab + CT (NIV+CT). Clinical efficacy and safety inputs were sourced from the EV-302, JAVELIN Bladder 100, and CheckMate 901 clinical trials. A microcosting approach supported by clinical expert validation was used to estimate per-patient direct medical costs (in Mexican pesos [Mex$]) for the first year, and the budget impact was then calculated for the target population using epidemiological data. Drug prices were obtained from COMPRANET (2024). The BIA compared a baseline scenario with CT+avelumab+BSC against an alternative scenario introducing EV+PEM and NIV+CT as 1L treatment options.
RESULTS: In the first-year cost-of-care model, the estimated total direct costs were $3,124,243 for EV+PEM, $1,431,290 for NIV+CT, $1,221,271 for CT+avelumab+BSC, and $588,428 for CT+BSC. Considering first-year total direct costs, the cost of treating 1 patient with EV+PEM would be equivalent to treating 3 patients with CT+avelumab+BSC. The cost of treating 1 patient with NIV+CT corresponds to treating 1 patient with CT+avelumab+BSC. The 5-year analysis showed an accumulated budget increase of $4,499,245,123 Mex (+141%) with EV+PEM, $934,005,618 Mex (+29%) with NIV+CT, and $361,901,661 Mex (+11.4%) with CT+avelumab+BSC.
CONCLUSIONS: This economic analysis showed that the introduction of EV+PEM and NIV+CT as 1L treatment options would likely result in higher overall direct healthcare costs. CT+avelumab+BSC showed the lowest projected budget impact increase among the evaluated regimens.
METHODS: The evaluated 1L treatment options were enfortumab vedotin + pembrolizumab (EV+PEM), platinum-based chemotherapy (CT) followed by avelumab 1L maintenance + best supportive care (BSC), CT+BSC, and nivolumab + CT (NIV+CT). Clinical efficacy and safety inputs were sourced from the EV-302, JAVELIN Bladder 100, and CheckMate 901 clinical trials. A microcosting approach supported by clinical expert validation was used to estimate per-patient direct medical costs (in Mexican pesos [Mex$]) for the first year, and the budget impact was then calculated for the target population using epidemiological data. Drug prices were obtained from COMPRANET (2024). The BIA compared a baseline scenario with CT+avelumab+BSC against an alternative scenario introducing EV+PEM and NIV+CT as 1L treatment options.
RESULTS: In the first-year cost-of-care model, the estimated total direct costs were $3,124,243 for EV+PEM, $1,431,290 for NIV+CT, $1,221,271 for CT+avelumab+BSC, and $588,428 for CT+BSC. Considering first-year total direct costs, the cost of treating 1 patient with EV+PEM would be equivalent to treating 3 patients with CT+avelumab+BSC. The cost of treating 1 patient with NIV+CT corresponds to treating 1 patient with CT+avelumab+BSC. The 5-year analysis showed an accumulated budget increase of $4,499,245,123 Mex (+141%) with EV+PEM, $934,005,618 Mex (+29%) with NIV+CT, and $361,901,661 Mex (+11.4%) with CT+avelumab+BSC.
CONCLUSIONS: This economic analysis showed that the introduction of EV+PEM and NIV+CT as 1L treatment options would likely result in higher overall direct healthcare costs. CT+avelumab+BSC showed the lowest projected budget impact increase among the evaluated regimens.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE359
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Oncology, SDC: Urinary/Kidney Disorders