Evaluating the Economic Value of First-Line (1L) Treatment Strategies for Locally Advanced or Metastatic Urothelial Carcinoma (la/mUC): Insights From the Portuguese Healthcare System
Author(s)
Nuno Silverio, MBA, RPh, PharmD1, Thitima Kongnakorn, PhD2, Solène De Boisvilliers, MSc3, Eszter Tichy, MSc4, Ahmed Elsada, MSc5.
1Merck, S.A., Alges, Portugal, 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, S.A., Alges, Portugal, 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.
Presentation Documents
OBJECTIVES: As innovative therapies for la/mUC continue to emerge, healthcare systems face financial pressures to adopt them within constrained budgets, highlighting the need for economic evaluations to support sustainable delivery of healthcare. This study assesses the economic value of 1L la/mUC treatments from the Portuguese healthcare system perspective.
METHODS: An economic model compared costs, both unadjusted and adjusted for progression-free survival (PFS) and overall survival (OS), over a 3-year horizon between 2 treatment strategies for 1L: chemotherapy induction with or without avelumab maintenance (chemo ± AVE) and enfortumab vedotin plus pembrolizumab (EV-P). For chemo ± AVE, the model included patients from 1L chemotherapy, including those with uncontrolled disease ineligible for maintenance therapy. Costs, estimated with input from local oncologists, included drug acquisition and administration, disease management, adverse events (AEs), and subsequent therapies. Treatment duration, PFS, OS, and AE incidence were derived from pivotal trials (JAVELIN Bladder 100; EV-302; KEYNOTE-361).
RESULTS: Over 3 years, the per-patient total cost of care was 56% lower with chemo ± AVE (€81,778) than with EV-P (€185,721), driven by higher EV-P drug costs. Costs per PFS month and OS month were lower with chemo ± AVE (€4,409 and €3,670 respectively) than with EV-P (€9,919 and €7,342 respectively). The incremental cost per additional survivor after 3 years from using EV-P instead of chemo ± AVE was estimated at €238,517 annually. Under a fixed budget, more patients can be treated with chemo ± AVE than with EV-P. Although the 3-year OS rate is estimated to be higher with EV-P than with chemo ± AVE, this does not offset the fewer patients treated with the former, resulting in more survivors after 3 years with the latter.
CONCLUSIONS: This study highlights the economic impact of adopting novel la/mUC therapies in Portugal, supporting value-oriented cancer care that balances costs with clinical considerations and efficacy outcomes.
METHODS: An economic model compared costs, both unadjusted and adjusted for progression-free survival (PFS) and overall survival (OS), over a 3-year horizon between 2 treatment strategies for 1L: chemotherapy induction with or without avelumab maintenance (chemo ± AVE) and enfortumab vedotin plus pembrolizumab (EV-P). For chemo ± AVE, the model included patients from 1L chemotherapy, including those with uncontrolled disease ineligible for maintenance therapy. Costs, estimated with input from local oncologists, included drug acquisition and administration, disease management, adverse events (AEs), and subsequent therapies. Treatment duration, PFS, OS, and AE incidence were derived from pivotal trials (JAVELIN Bladder 100; EV-302; KEYNOTE-361).
RESULTS: Over 3 years, the per-patient total cost of care was 56% lower with chemo ± AVE (€81,778) than with EV-P (€185,721), driven by higher EV-P drug costs. Costs per PFS month and OS month were lower with chemo ± AVE (€4,409 and €3,670 respectively) than with EV-P (€9,919 and €7,342 respectively). The incremental cost per additional survivor after 3 years from using EV-P instead of chemo ± AVE was estimated at €238,517 annually. Under a fixed budget, more patients can be treated with chemo ± AVE than with EV-P. Although the 3-year OS rate is estimated to be higher with EV-P than with chemo ± AVE, this does not offset the fewer patients treated with the former, resulting in more survivors after 3 years with the latter.
CONCLUSIONS: This study highlights the economic impact of adopting novel la/mUC therapies in Portugal, supporting value-oriented cancer care that balances costs with clinical considerations and efficacy outcomes.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE443
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Oncology, Urinary/Kidney Disorders