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Cost-Effectiveness of Avelumab Maintenance Therapy for Advanced or Metastatic Urothelial Carcinoma in the United States

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Abstract

Introduction

The JAVELIN Bladder 100 trial showed that maintenance avelumab therapy after chemotherapy improved the survival of patients with advanced or metastatic urothelial carcinoma. We analyzed the cost-effectiveness of maintenance therapy with avelumab plus best supportive care (BSC) in patients with advanced or metastatic urothelial carcinoma after receiving first-line platinum-based chemotherapy from the US payer perspective.

Methods

A Markov model was used to analyze the economic outcomes of maintenance avelumab plus BSC (avelumab strategy) in the treatment of urothelial carcinoma. The clinical data were derived from the JAVELIN Bladder 100 trial. All cost information was obtained from Medicare and published literature. The total cost, total life years (LYs), total quality-adjusted LYs (QALYs), incremental cost-effectiveness ratio (ICER), and incremental net health benefit (INHB) were calculated. One-way sensitivity analysis and probabilistic sensitivity analysis were also performed.

Results

Our results showed that avelumab strategy versus BSC strategy cost US $176,352 and $238,661 and yielded an additional 0.465 and 1.007 QALY in all patients with unknown programmed-death ligand 1 (PD-L1) status and the PD-L1-positive subpopulation, respectively, which led to an ICER of $102,365/QALY and $106,253/QALY gained. In all patients with unknown PD-L1 status, maintenance avelumab plus BSC therapy guiding by PD-L1 expression testing (PD-L1-guided strategy) compared with the avelumab strategy and BSC strategy resulted in ICER of $105,360/QALY and $122,653/QALY, respectively. The probabilities of the avelumab strategy and the PD-L1-guided strategy being cost-effective in the simultaneous competition of the three strategies were 38.49% and 48.82%. In patients with PD-L1-positive status, the avelumab strategy had an 87.51% probability of cost-effectiveness. The most influential parameter for the model was the cost of avelumab and pembrolizumab.

Conclusions

This analysis demonstrated that maintenance therapy with avelumab plus BSC may be a cost-effective option for patients with advanced or metastatic urothelial carcinoma at a willingness-to-pay (WTP) threshold of $150,000/QALY, especially for patients with PD-L1-positive status.

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Acknowledgements

Funding

The work was supported by grants from the National Natural Science Foundation of China (Grant numbers 82073818 and 71874209); and the Key Science-Technology Research and Development Program of Hunan Province (Grant number 2020JJ8046); and the Hunan Provincial Natural Science Foundation of China (Grant number 2019JJ40411). The journal’s Rapid Service Fee was funded by the study sponsor.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Author Contributions

Study design and supervision: Xiaomin Wan and Chongqing Tan; Data analysis and interpretation: Sini Li, Lidan Yi, Xia Luo; Data collection: Liubao Peng, Liting Wang, Shuxia Qin, Qiao Liu; Manuscript writing: Ye Peng and Zhihua She; Final approved of manuscript: All authors.

Disclosures

Ye Peng, Zhihua She, Liubao Peng, Qiao Liu, Lidan Yi, Xia Luo, Sini Li, Liting Wang, Shuxia Qin, Xiaomin Wan and Chongqing Tan confirm they have no conflicts of interest to declare.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author notes

  1. Ye Peng and Zhihua She contributed equally to this work.

Authors and Affiliations

  1. Department of Pharmacy, The Second Xiangya Hospital of Central South University, No.139 Renmin Middle Road, Changsha, 410011, Hunan, China

    Ye Peng, Liubao Peng, Qiao Liu, Lidan Yi, Xia Luo, Sini Li, Liting Wang, Shuxia Qin, Xiaomin Wan & Chongqing Tan

  2. Department of Medical Administration, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410008, Hunan, China

    Zhihua She

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  1. Ye Peng
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Corresponding authors

Correspondence to Xiaomin Wan or Chongqing Tan.

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Peng, Y., She, Z., Peng, L. et al. Cost-Effectiveness of Avelumab Maintenance Therapy for Advanced or Metastatic Urothelial Carcinoma in the United States. Adv Ther 38, 5710–5720 (2021). https://doi.org/10.1007/s12325-021-01950-0

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