Presentation (CTI)

OBJECTIVES: Cost-effectiveness analysis from a Belgian healthcare payer perspective for perioperative pembrolizumab and enfortumab vedotin versus surgery with or without adjuvant nivolumab in adult muscle-invasive bladder cancer patients who are ineligible for treatment with cisplatin-based chemotherapy.
METHODS: A Markov cohort structure model was developed based upon three health states (event-free [EF], progressed or recurrent disease [PRD], and death) to estimate the incremental cost per quality-adjusted life year (QALY) gained. Transition probabilities from the health states EF and DR were estimated respectively based upon patient-level time-to-event data from the KEYNOTE-905 trial and the efficacy and market shares of subsequent treatments received in the DR health state. Costs were estimated in 2026 Euros. Utilities and adverse event disutilities were based on EQ-5D-5L patient data collected in KEYNOTE-905 for the EF health state and from patient data collected in KEYNOTE-A39 for the DR health state. Model uncertainties were tested in deterministic- and probabilistic sensitivity analysis and scenario analysis.
RESULTS: Over a lifetime time horizon, perioperative pembrolizumab + enfortumab vedotin was associated with an additional cost of 25.225€ and 2,95 QALYs gains versus surgery with or without adjuvant nivolumab in the target population. The incremental cost-effectiveness ratio for perioperative pembrolizumab + enfortumab vedotin was 8.554€/QALY versus. the comparator-arm. Sensitivity analysis showed robustness in the model results. The ICER was below a willingness-to-pay threshold of €40.000/QALY across all scenario analysis, deterministic simulations and in 95,5% of probabilistic simulations.
CONCLUSIONS: Perioperative pembrolizumab and enfortumab vedotin for the treatment of muscle-invasive bladder cancer patients who are ineligible for cisplatin-based chemotherapy can be considered a cost-effective treatment strategy in Belgium.