Presentation (CTI)

OBJECTIVES: To conduct a systematic literature review assessing direct and indirect costs, healthcare resource utilization, and cost-effectiveness evidence among patients with cisplatin-ineligible muscle-invasive bladder cancer (MIBC).
METHODS: A systematic search of EMBASE, MEDLINE, and EconLit was conducted for publications from January 2015 to December 2025. Observational studies and economic evaluations reporting costs, resource utilization, economic burden, or cost-effectiveness outcomes in patients with cisplatin-ineligible MIBC were included from USA, Canada, and EU5.
RESULTS: Of 202 abstracts screened, 29 publications underwent full-text review, and five studies met inclusion criteria. Four studies were cost-effectiveness models (USA [n=2], UK, and Canada), and one study was a USA population-level, claims-based analysis. Four studies reported costs, while one focused on healthcare resource utilization. Immune checkpoint inhibitors (ICIs), including pembrolizumab (P) and nivolumab (N), and the antibody-drug conjugate with ICI combination enfortumab vedotin plus pembrolizumab (EV+P), were associated with higher costs than conventional gemcitabine-cisplatin (GC) chemotherapies (EV+P vs GC: $769,262 vs $261,296 [CAD]; £121,214 vs £40,875; P vs GC: $225,334 vs $66,773 [USD]). Patients with recurrent MIBC reported significantly higher bladder cancer-related inpatient admissions (2.7 vs 0.6 admissions per patient per year [PPPY]), emergency department visits (0.5 vs 0.1 PPPY), and outpatient visits (14.4 vs 4.0 visits PPPY) compared with those without recurrence (all P <0.001). Despite high acquisition costs, EV+P demonstrated gains of 1.24-1.35 quality-adjusted life-years (QALYs) versus GC, while pembrolizumab yielded mean gains of 2.58 life-years and 2.01 QALYs. These regimens were generally not cost-effective across Canada, the UK, and the USA, except in select subgroups with high PD-L1 expression.
CONCLUSIONS: Economic evidence in cisplatin‑ineligible MIBC is limited. Available cost‑effectiveness analyses are largely model-based and rely on trial data with cost inputs drawn from broader MIBC populations. Additional real‑world studies are needed to better characterize the economic burden and treatment value in this population.