Cost-Effectiveness Analysis of Pembrolizumab in Combination With Enfortumab Vendotin for First-Line Treatment of Previously Untreated Locally Advanced or Metastatic Urothelial Carcinoma
Author(s)
Nikolaos Yfantopoulos, MSc1, ANASTASIOS SKROUMPELOS, PhD2, Antonis Karokis, MSc1, George Emmanouil, PhD1, Akanksha Rai, PhD3, Diksha Vohra, PhD3, Shujing (Shirley) Zhang, PhD4.
1MSD, Alimos, Greece, 2MSD, Athens, Greece, 3CHEORS, Pennsylvania, PA, USA, 4Merck, Pennsylvania, PA, USA.
1MSD, Alimos, Greece, 2MSD, Athens, Greece, 3CHEORS, Pennsylvania, PA, USA, 4Merck, Pennsylvania, PA, USA.
OBJECTIVES: Greece has the fourth highest incidence of bladder cancer in the European Union. Pembrolizumab in combination with enfortumab vendotin (EV) is indicated for the treatment of advanced or recurrent bladder cancer based on the results of KEYNOTE-A39 clinical trial. The present study aims to assess cost-effectiveness of pembrolizumab in combination with EV versus gemcitabine plus carboplatin/cisplatin (GP/GC), followed by avelumab maintenance for those who have not progressed, in Greece.
METHODS: A partitioned survival model with three health states (progression-free, progressed disease and death) was developed in Microsoft Excel, adopting payer’s perspective with a lifetime horizon of 32 years. Clinical, safety and quality of life data were drawn from the KEYNOTE-A39 clinical trial. Primary outcomes were patients’ life years gained (LYG), quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratio (ICER) per LYg and per QALY. Both costs and outcomes were discounted at 3.0% per annum. Α one-way sensitivity analysis (OWSA) was undertaken to examine the most influential parameters on the results and a probabilistic sensitivity analysis (PSA) was conducted to account for uncertainty in the model.
RESULTS: The model showed that, over a lifetime horizon, pembrolizumab in combination with EV resulted in 109,115 € additional costs compared to GP/GC+/-avelumab, extended LYs by 2.9 years and increased QALYs by 1.7 years. The ICER was estimated to be 63,639€/QALY, which is below the national cost effectiveness threshold for Greece (64,926€/QALY). OWSA indicated that the model's most influential parameters included a shorter time horizon and the assumption that the treatment effect is waning. PSA confirmed the deterministic analysis results, supporting the robustness of our results.
CONCLUSIONS: Pembrolizumab in combination with EV is a cost-effective treatment option- compared to GP/GC+/-avelumab- that optimizes health outcomes and provides a practice changing paradigm for first-line treatment of previously untreated locally advanced or metastatic urothelial carcinoma in Greece.
METHODS: A partitioned survival model with three health states (progression-free, progressed disease and death) was developed in Microsoft Excel, adopting payer’s perspective with a lifetime horizon of 32 years. Clinical, safety and quality of life data were drawn from the KEYNOTE-A39 clinical trial. Primary outcomes were patients’ life years gained (LYG), quality-adjusted life years (QALYs), total costs and incremental cost-effectiveness ratio (ICER) per LYg and per QALY. Both costs and outcomes were discounted at 3.0% per annum. Α one-way sensitivity analysis (OWSA) was undertaken to examine the most influential parameters on the results and a probabilistic sensitivity analysis (PSA) was conducted to account for uncertainty in the model.
RESULTS: The model showed that, over a lifetime horizon, pembrolizumab in combination with EV resulted in 109,115 € additional costs compared to GP/GC+/-avelumab, extended LYs by 2.9 years and increased QALYs by 1.7 years. The ICER was estimated to be 63,639€/QALY, which is below the national cost effectiveness threshold for Greece (64,926€/QALY). OWSA indicated that the model's most influential parameters included a shorter time horizon and the assumption that the treatment effect is waning. PSA confirmed the deterministic analysis results, supporting the robustness of our results.
CONCLUSIONS: Pembrolizumab in combination with EV is a cost-effective treatment option- compared to GP/GC+/-avelumab- that optimizes health outcomes and provides a practice changing paradigm for first-line treatment of previously untreated locally advanced or metastatic urothelial carcinoma in Greece.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE162
Topic
Economic Evaluation, Health Technology Assessment
Disease
Oncology, Urinary/Kidney Disorders