COST OF CARE AND BUDGET IMPACT OF NOVEL FIRST-LINE (1L) TREATMENTS IN PATIENTS WITH LOCALLY ADVANCED OR METASTATIC UROTHELIAL CARCINOMA (LA/MUC) IN COSTA RICA
Author(s)
Paola Jaramillo, MSc1, Pieralessandro Lasalvia, MD1, José A. Castro, MBA, MD2, Stephanie Perichón, MD3, Mirko Maceda, MD4, Veronica Hernández Orellana, MD4, Diana Tellez, MPH, PhD, MD4, Juliana Restrepo, MBA5.
1NeuroEconomix, Bogotá, Colombia, 2Costa Rican Social Security Fund, San José, Costa Rica, 3Hospital México, San José, Costa Rica, 4Merck S.A., Panamá, Panamá, an affiliate of Merck KGaA, Darmstadt, Germany, 5Merck S.A., Bogotá, Colombia, an affiliate of Merck KGaA, Darmstadt, Germany.
1NeuroEconomix, Bogotá, Colombia, 2Costa Rican Social Security Fund, San José, Costa Rica, 3Hospital México, San José, Costa Rica, 4Merck S.A., Panamá, Panamá, an affiliate of Merck KGaA, Darmstadt, Germany, 5Merck S.A., Bogotá, Colombia, an affiliate of Merck KGaA, Darmstadt, Germany.
OBJECTIVES: To evaluate first-year treatment costs and conduct a 5-year budget impact analysis (BIA) of approved 1L therapies for la/mUC in Costa Rica from the national payer perspective.
METHODS: This analysis included patients with la/mUC initiating 1L systemic anticancer therapy, from the perspective of the Costa Rican national payer. Four therapeutic strategies were evaluated: nivolumab (NIV) + chemotherapy (CT), enfortumab vedotin + pembrolizumab (EV+PEM), CT followed by avelumab + best supportive care (BSC), and CT+BSC. Efficacy and safety inputs were sourced from the CheckMate 901, EV-302, and JAVELIN Bladder 100 trials. Direct medical costs (Costa Rican colón [₡]) considered drug acquisition and administration, disease management, grade ≥3 adverse events, and subsequent treatment lines. Unit prices were derived from SICOP (2024) and Costa Rican Social Security Fund reports. Costs were estimated on a per-patient basis in the cost-of-care model and for the target population BIA. The BIA compared current practice (CT+avelumab+BSC) with an adoption scenario introducing EV+PEM and NIV+CT into 1L treatment.
RESULTS: The estimated total direct costs in the first year were: EV+PEM (₡119,286,784), NIV+CT (₡75,339,069), CT+avelumab+BSC (₡70,752,627), and CT+BSC (₡36,301,754). In the first year, the CT+BSC strategy represented the lowest total direct medical costs, followed by CT+avelumab+BSC, with higher overall spending observed for NIV+CT and EV+PEM. With the total cost of treating 1 patient with EV+PEM, 2 patients could be treated with CT+avelumab+BSC or 1 with NIV+CT. This 5-year analysis showed an accumulated budget increase total direct medical costs of ₡1,166,738,554 (+26%) with EV+PEM, ₡628,194,694 (+14.1%) with NIV+CT, and ₡344,228,189 (+7.7%) with CT+avelumab+BSC.
CONCLUSIONS: In this economic analysis evaluating 1L la/mUC regimens in Costa Rica, CT+BSC and CT+avelumab+BSC represented the lowest total direct first-year medical costs, whereas higher expenditures were observed with NIV+CT and EV+PEM. CT+avelumab+BSC showed the lowest net incremental budget impact over a cumulative 5-year period.
METHODS: This analysis included patients with la/mUC initiating 1L systemic anticancer therapy, from the perspective of the Costa Rican national payer. Four therapeutic strategies were evaluated: nivolumab (NIV) + chemotherapy (CT), enfortumab vedotin + pembrolizumab (EV+PEM), CT followed by avelumab + best supportive care (BSC), and CT+BSC. Efficacy and safety inputs were sourced from the CheckMate 901, EV-302, and JAVELIN Bladder 100 trials. Direct medical costs (Costa Rican colón [₡]) considered drug acquisition and administration, disease management, grade ≥3 adverse events, and subsequent treatment lines. Unit prices were derived from SICOP (2024) and Costa Rican Social Security Fund reports. Costs were estimated on a per-patient basis in the cost-of-care model and for the target population BIA. The BIA compared current practice (CT+avelumab+BSC) with an adoption scenario introducing EV+PEM and NIV+CT into 1L treatment.
RESULTS: The estimated total direct costs in the first year were: EV+PEM (₡119,286,784), NIV+CT (₡75,339,069), CT+avelumab+BSC (₡70,752,627), and CT+BSC (₡36,301,754). In the first year, the CT+BSC strategy represented the lowest total direct medical costs, followed by CT+avelumab+BSC, with higher overall spending observed for NIV+CT and EV+PEM. With the total cost of treating 1 patient with EV+PEM, 2 patients could be treated with CT+avelumab+BSC or 1 with NIV+CT. This 5-year analysis showed an accumulated budget increase total direct medical costs of ₡1,166,738,554 (+26%) with EV+PEM, ₡628,194,694 (+14.1%) with NIV+CT, and ₡344,228,189 (+7.7%) with CT+avelumab+BSC.
CONCLUSIONS: In this economic analysis evaluating 1L la/mUC regimens in Costa Rica, CT+BSC and CT+avelumab+BSC represented the lowest total direct first-year medical costs, whereas higher expenditures were observed with NIV+CT and EV+PEM. CT+avelumab+BSC showed the lowest net incremental budget impact over a cumulative 5-year period.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE464
Topic
Economic Evaluation
Topic Subcategory
Budget Impact Analysis, Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Oncology, SDC: Urinary/Kidney Disorders