Cost-effectiveness of avelumab first-line maintenance therapy for adult patients with locally advanced or metastatic urothelial carcinoma in France

F. Porte, A. Granghaud, J. Chang, M. Kearney, A. Morel, I. Plessala, H. Cawston, J. Roiz, Y. Xiao, M.-N. Solbes, P. Lambert, A. Ravaud, Y. Loriot, A. Thiery-Vuillemin and Pierre Lévy
Additional contact information
A. Ravaud: CHU Bordeaux - Centre Hospitalier Universitaire de Bordeaux
Y. Loriot: IGR - Institut Gustave Roussy
A. Thiery-Vuillemin: Pôle cancérologie (CHRU Besançon) - CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
Pierre Lévy: Legos - Laboratoire d'Economie et de Gestion des Organisations de Santé - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres, LEDa - Laboratoire d'Economie de Dauphine - IRD - Institut de Recherche pour le Développement - Université Paris Dauphine-PSL - PSL - Université Paris Sciences et Lettres - CNRS - Centre National de la Recherche Scientifique

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Abstract: Background: This study evaluated the cost-effectiveness of avelumab first-line (1L) maintenance therapy plus best supportive care (BSC) versus BSC alone for adults with locally advanced or metastatic urothelial carcinoma (la/mUC) that had not progressed following platinum-based chemotherapy in France. Methods: A three-state partitioned survival model was developed to assess the lifetime costs and effects of avelumab plus BSC versus BSC alone. Data from the phase 3 JAVELIN Bladder 100 trial (NCT02603432) were used to inform estimates of clinical and utility values considering a 10-year time horizon and a weekly cycle length. Cost data were estimated from a collective perspective and included treatment acquisition, administration, follow-up, adverse event–related hospitalization, transport, post-progression, and end-of-life costs. Health outcomes were measured in quality-adjusted life-years (QALYs) and life-years gained. Costs and clinical outcomes were discounted at 2.5% per annum. Incremental cost-effectiveness ratios (ICERs) were used to compare cost-effectiveness and willingness to pay in France. Uncertainty was assessed using a range of sensitivity analyses. Results: Avelumab plus BSC was associated with a gain of 2.49 QALYs and total discounted costs of €136,917; BSC alone was associated with 1.82 QALYs and €39,751. Although avelumab plus BSC was associated with increased acquisition costs compared with BSC alone, offsets of −€20,424 and −€351 were observed for post-progression and end-of-life costs, respectively. The base case analysis ICER was €145,626/QALY. Sensitivity analyses were consistent with the reference case and showed that efficacy parameters (overall survival, time to treatment discontinuation), post-progression time on immunotherapy, and post-progression costs had the largest impact on the ICER. Conclusions: This analysis demonstrated that avelumab plus BSC is associated with a favorable cost-effectiveness profile for patients with la/mUC who are eligible for 1L maintenance therapy in France.

Keywords: Bladder; Cancer treatment; Cost-effectiveness analysis; Bladder cancer; Oncology; Urology; Palliative care; Extrapolation (search for similar items in EconPapers)
Date: 2024-05
Note: View the original document on HAL open archive server: https://hal.science/hal-04929332v1
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Published in PLoS ONE, 2024, 19 (5), ⟨10.1371/journal.pone.0302548⟩

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Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-04929332

DOI: 10.1371/journal.pone.0302548

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