Economic Evaluation of Contemporary First-Line (1L) Treatments for Locally Advanced or Metastatic Urothelial Carcinoma La/mUC in France: A Sensitivity Analysis
Author(s)
Marie CALLIES DE SALIES, PharmD1, Thitima Kongnakorn, PhD2, Solene de Boisvilliers, MSc3, Eszter Tichy, MSc4, Xavier Bresse, PharmD, MSc1, Heidi Portalier, MSc1, Ahmed Elsada, MSc5.
1Merck Serono S.A.S., Lyon, France, an affiliate of Merck KGaA, Darmstadt, Germany, 2PPD Evidera Health Economics & Market Access, Thermofisher Scientific, Bangkok, Thailand, 3PPD Evidera Health Economics & Market Access, Thermofisher Scientific, Paris, France, 4PPD Evidera Health Economics & Market Access, Thermofisher Scientific, Budapest, Hungary, 5Merck Serono Ltd., Feltham, UK, an affiliate of Merck KGaA, Darmstadt, Germany.
1Merck Serono S.A.S., Lyon, France, an affiliate of Merck KGaA, Darmstadt, Germany, 2PPD Evidera Health Economics & Market Access, Thermofisher Scientific, Bangkok, Thailand, 3PPD Evidera Health Economics & Market Access, Thermofisher Scientific, Paris, France, 4PPD Evidera Health Economics & Market Access, Thermofisher Scientific, Budapest, Hungary, 5Merck Serono Ltd., Feltham, UK, an affiliate of Merck KGaA, Darmstadt, Germany.
OBJECTIVES: Given the increasing financial burden of managing la/mUC, this study evaluates the economic implications of 1L la/mUC treatments from the perspective of the French national healthcare system, focusing on the sensitivity of those implications to underlying assumptions.
METHODS: A health economic model compared, over 3 years, costs and clinical outcomes of 2 strategies for 1L treatment: chemotherapy with or without maintenance avelumab (chemo ± AVE), and enfortumab vedotin plus pembrolizumab (EV-P). Costs (2024€)—including drug acquisition (at list prices), administration, disease management (DM), adverse events (AEs), and subsequent therapies—were estimated using mean clinical outcomes from published trials (EV-302, JAVELIN Bladder 100) and expert elicitation. To assess uncertainty, various sensitivity analyses were conducted, including those around clinical inputs, drug acquisition, DM and AE costs, and proportions of patients with chemotherapy-controlled disease and those with controlled disease who received maintenance avelumab.
RESULTS: In the base case, the total cost of care per patient over 3 years was 53% lower with chemo ± AVE (€76,257) versus EV-P (€164,340). Cost per overall survival (OS) month was 47% lower with chemo ± AVE (€3,417 versus €6,497). Sensitivity analyses showed chemo ± AVE costs were 45-54% lower overall and 36-49% lower per OS month than EV-P. A scenario assuming all patients with chemotherapy-controlled disease receive maintenance avelumab resulted in a total cost of €83,989 and a cost per OS month of €3,686 for chemo ± AVE. Applying a discount of 36.2% to the prices of avelumab and EV-P reduced total costs to €62,202 for chemo ± AVE and €114,008 for EV-P.
CONCLUSIONS: Through robust and consistent results, this simulation exercise confirms the importance of economic considerations in delivering efficient and sustainable cancer care for la/mUC.
METHODS: A health economic model compared, over 3 years, costs and clinical outcomes of 2 strategies for 1L treatment: chemotherapy with or without maintenance avelumab (chemo ± AVE), and enfortumab vedotin plus pembrolizumab (EV-P). Costs (2024€)—including drug acquisition (at list prices), administration, disease management (DM), adverse events (AEs), and subsequent therapies—were estimated using mean clinical outcomes from published trials (EV-302, JAVELIN Bladder 100) and expert elicitation. To assess uncertainty, various sensitivity analyses were conducted, including those around clinical inputs, drug acquisition, DM and AE costs, and proportions of patients with chemotherapy-controlled disease and those with controlled disease who received maintenance avelumab.
RESULTS: In the base case, the total cost of care per patient over 3 years was 53% lower with chemo ± AVE (€76,257) versus EV-P (€164,340). Cost per overall survival (OS) month was 47% lower with chemo ± AVE (€3,417 versus €6,497). Sensitivity analyses showed chemo ± AVE costs were 45-54% lower overall and 36-49% lower per OS month than EV-P. A scenario assuming all patients with chemotherapy-controlled disease receive maintenance avelumab resulted in a total cost of €83,989 and a cost per OS month of €3,686 for chemo ± AVE. Applying a discount of 36.2% to the prices of avelumab and EV-P reduced total costs to €62,202 for chemo ± AVE and €114,008 for EV-P.
CONCLUSIONS: Through robust and consistent results, this simulation exercise confirms the importance of economic considerations in delivering efficient and sustainable cancer care for la/mUC.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE378
Topic
Economic Evaluation
Disease
Oncology, Urinary/Kidney Disorders