OBJECTIVES : To systematically identify published CE evidence through a review of studies reporting economic and humanistic outcomes for the evaluation of 1L interventions in patients with advanced or mUC.

METHODS : An SLR was conducted using a predefined framework on May 22, 2020. Publications were identified within the Embase, Medline (In-Process), EconLit, and Centre for Reviews and Dissemination databases and relevant health technology assessment websites with no time limit, as well as and conference proceedings of the International Society of Pharmacoeconomic and Outcomes Research from 2018 to 2020. All citations during title/abstract and full-text screening were reviewed by two independent reviewers.

RESULTS : Among 2,112 publications identified, 2 CE and 3 cost-utility analyses met the pre-defined criteria for inclusion. Models were published between 2014 and 2019. Two models were published from a United Kingdom (UK) perspective and one each from the perspectives of the United States (US), Sweden, and Norway. Methodologies included partitioned-survival models (n=3), a multi-indication model (n=1), and a trial-based cost and utility analysis (n=1). Pembrolizumab (n=4) and gemcitabine+carboplatin (n=3) were the most commonly analzyed interventions. In a Swedish study, the incremental cost-utility ratio (ICUR), measured in costs per quality-adjusted life-years (QALY) gained, for pembrolizumab was 53,055 SEK/QALY versus gemcitabine+carboplatin and 54,415 SEK/QALY versus gemcitabine monotherapy. The ICUR for pembrolizumab versus gemcitabine+carboplatin was $81,493/QALY in the US and £35,016/QALY in England. The ICUR for pembrolizumab versus standard-of-care chemotherapy was 795,000 NOK/QALY in Norway. The ICUR for gemcitabine+cisplatin versus MVAC (methotrexate, vinblastine, doxorubicin, cisplatin) was £22,925/QALY in the UK.

CONCLUSIONS : Cost-effectiveness results for 1L interventions among patients with advanced or mUC are limited, with only five studies available in the literature. Further analyses are needed to evaluate the CE of existing standard-of-care and emergent therapies for 1L treatment of advanced or mUC.